The health reform law (PPACA) outlines 'essential benefits' that plans must offer after January 1, 2014. These benefits break down into ten broad categories, from hospitalization, to prescription drugs, to rehabilitative and habilitative services. Under the law, the Secretary of Health and Human Services will decide how detailed to make the essential benefits package and what exactly to put in it.
Keep in mind:
- Insurance policies must cover these benefits in order to be certified and offered in Exchanges, and all Medicaid State plans must cover these services.
- Individual and small group plans offered outside the exchanges must include the essential health benefits package.
- All new group health plans must adjust cost-sharing and deductibles to the limits specified for the essential health benefits package.
- The benefits directive does not apply to large group plans.
- How long will the process of defining essential benefits play out?
- To what extent will the directive, regardless of details specified or not, impact the political process? Will any meaningful resolution occur prior to the 2012 election?
- To what extent does the law permit states to administer their own benefits irrespective of federal guidelines? Will they take advantage of this?
- Defining 'Essential' Care, Wall Street Journal
- Defining Essential Benefits: Congress' Once and Future Role, Health Affairs
- 'Essential Benefits' A Complex Question in New Health-Care Law, Washington Post
- Is Choice of Physician and Hospital an Essential Benefit, Journal of the American Medical Association