Health Insurance Consumer InformationThe Secretary shall provide grants to States or to the Exchanges operating in those States to set up, expand and give support for:
Offices of consumer assistance for health insurance or health insurance “ombudsman” programs (pp 37, lines 22-34, pp 38. Lines 1 -5).
- To get a grant, eligibility requires that States designate an independent office for health insurance consumer assistance (or an ombudsman).
- Such office must work directly or in coordination with insurance regulators and consumer assistance organizations in that State. It must respond to complaints and inquiries with regard to Federal insurance requirements and under State law (pp 38, lines6- 15).
- Any State that receives a grant must comply with the Secretary’s guidelines for carrying out such a grant (pp 38, lines 16-19).
Duties of the Office of Health Insurance Consumer Assistance
Either the office of consumer health insurance assistance of ombudsman shall:
- Help with filing appeals, complaints. This includes filing appeals with the internal appeal process of an individual insurer, group plan. It also includes provision of information about any external process of appeal (pp 38, lines 22 – 24, pp 39, lines 1 -2).
- Engage in collection, tracking, quantifying problems and inquiries relating to consumers (pp 39, lines 3-4).
- Educate and inform consumers about their rights and responsibilities with regard to group health plans and or health insurance coverage (pp 39, lines 5-7).
- Assist consumers in enrolling in group health plan or health insurance coverage via the provision of referrals, information and assistance (pp 39, lines 8 – 10)
- Assist and provide problem resolution for consumers in acquiring premium tax credits under section 36B of the Internal Revenue Code of 1986 (pp 39, lines 11-13).
- As a condition of receiving a grant, any office of health insurance consumer assistance or ombudsman program must report data to the Secretary relating to the types of problems and inquiries encountered by consumers. Such data will be used by the Secretary to spotlight areas where additional enforcement action is need ed. The Secretary will share this information with State insurance regulators, the Secretary of Labor, and the4 Secretary of the Treasury. Each secretary will use said information in the enforcement activities of the respective agency (pp 39, lines 14-23).
- Funding of these grants comes from an appropriation of $30,000,000 for the first fiscal year in order to carry out the stipulations of this section. This amount will remain available without “fiscal year” limitation (pp 40, lines 1-6).
- Also, it is appropriated to the Secretary for each fiscal year “such sums as may be necessary” to carry out this section (pp 40, lines 7 – 11).
Healthcare Reform summaries based on the original text of the Patient Protection and Affordable Care Act (Passed by the US Senate 12-24-09. Passed by the US House of Representatives 3-21-10. This summary is for informational purposes only. Actual provisions and any amended portions of the bills apply).