The 2010 health care law continues to pile on bureaucracy and confusion as employers and health insurance providers come up against looming deadlines while trying to navigate unclear rules, exacting mandates, and undefined provisions.

After a nine-month delay, the Department of Health and Human Services (HHS) and the Department of Labor are rushing towards finalizing a rule to develop summary of benefits and coverage forms for health insurance plans. These forms are intended to explain benefits and costs in easy-to-understand terms so that consumers can comparison shop for the best coverage. The materials include a benefits summary chart, definitions of commonly used terms, and two pages of coverage fact labels that show how much a plan pays for the average national cost of three common medical conditions. The forms must not exceed four pages in length and may not include print smaller than 12 point font.

Business and insurance advocates argue that the new forms are too prescriptive and do not take into account the different products offered by insurance companies, nor the variables of different customers and markets. “There are still a lot of holes and things that are undefined and it’s not clear what the demands on the industry are going to be,” says Katie Mahoney, Executive Director of Health Policy at the U.S. Chamber of Commerce.

The health care law calls for the forms to be distributed by all insurers and employers to more than 160 million health plan enrollees beginning on March 23, 2012. However, because of the administration’s long delay, the final rule is still under review at the Office of Management and Budget, making compliance by the March date all but impossible, insurance and business representatives say.

In addition, many large employers with self-insured health plans are already required to provide similar health plan information, meaning that they will have to prepare two sets of plan information, thereby adding paperwork for the employer and confusion for the consumer, says Justine Handelman, Vice President of Legislative and Regulatory Policy for the BlueCross BlueShield Association. “We all have the same goal, which is to provide meaningful information to our consumers in a way that makes sense for them,” says Handelman.

Handelman says the insurance industry is hoping to amend the final rule to make it more workable, but at the very least she says HHS should exempt self-insured employers from the summary of benefits and coverage requirements and give smaller group and individual plan providers more time to comply.

Further complicating compliance with the summary of benefits and coverage requirements is the fact that HHS has dragged its feet on the issue of defining essential health benefits, instead punting the issue to the individual states.

Essential health benefits are a set of health care service categories that must be covered by certain health plans beginning in 2014.

Rather than develop a national essential health benefit standard, which was largely expected, HHS issued a guidance “bulletin” in December that said that states could develop their own essential health benefits packages, as long as any plan chosen by a state covers 10 required categories of care, including emergency services, maternity and prescription drugs. 

“Congress intended that the federal government, through the Secretary of HHS, undertake the time-consuming and costly research, analysis, and decision-making process to define an operational set of essential benefits,” the Chamber stated in comments it submitted to the agency on February 3. “Instead, HHS has chosen an approach that shifts the burden of assembling and analyzing data to define essential benefits to the states but has not provided any funding to enable the states to accomplish this complex and labor-intensive task.”

Without knowing what benefits insurers will be required to cover, it’s difficult to develop and disseminate a summary of benefits and coverage, Handelman points out.