Thursday, October 31, 2013

When it comes to health insurance, what’s essential?

New laws, and new benefits.  From the elimination of catastrophic health plans to the introduction of metallic health plans, changes in health care are one of the hottest topics of discussion in the news lately.  So, what’s essential?

Individual and small group health plans are required under the Affordable Care Act to offer a minimum set of health services called “essential health benefits,” beginning in 2014.  People who have plans that do not meet these minimum standards may receive a notice that their plan is being replaced by one that includes additional mandatory benefits. 

Although the rule does not apply to all health plans, most individual and small group plans must now offer coverage for all of the following 10 essential health benefit categories:
  • Ambulatory patient services
  •  Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision

While the federal government has determined the broad categories that must be covered, each state determines the specific services that are covered under each category.  Each state has selected a “benchmark” health plan to define the specific services that must be included in the state’s essential health benefits package.

Many health plans have not traditionally included the services that are now required by the federal and state governments, such as pediatric oral and vision care.  For 2014, insurers must redesign such plans to cover all required services.  An insurer may also end plans that don’t meet the requirements and offer an alternative plan that does.

For more information about essential health benefits, click here to view an overview of essential health benefits, frequently asked questions or “FAQs,” and more.

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