Wednesday, February 29, 2012
Tweet[IWS] Kaiser: Private Insurance Benefits and Cost-Sharing Under the ACA [28 February 2012]
IWS Documented News Service
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Institute for Workplace Studies----------------- Professor Samuel B. Bacharach
School of Industrial & Labor Relations-------- Director, Institute for Workplace Studies
Cornell University
16 East 34th Street, 4th floor---------------------- Stuart Basefsky
New York, NY 10016 -------------------------------Director, IWS News Bureau
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Kaiser Family Foundation
Health Reform Source
Notes on Health Insurance and Reform
February 28, 2012
Private Insurance Benefits and Cost-Sharing Under the ACA
Abstract: Explains the latest guidance from the Department of Health and Human Services on essential health benefits and cost-sharing and what it could mean for consumers.
[excerpt]
The Department of Health and Human Services (HHS) recently released guidance on the two key components that determine the level of protection that private insurance plans will provide to consumers under health reform. The first involves the services that insurance plans must cover, and the second involves how much patients must pay out-of-pocket for those services.
The Affordable Care Act (ACA) establishes new rules for what insurers must provide for both components starting in 2014. This requires balancing sometimes competing goals of standardizing plan design -- which provides certain guarantees to consumers no matter where they live or what plan they choose and facilitates comparisons across insurers – and permitting more diversity of choices in the marketplace. With recent guidance issued by the federal government on benefits and patient cost-sharing, how insurance options could vary by plan and by state has become quite a bit clearer.
Covered Services: The ACA requires HHS to identify essential health benefits for insurance plans offered in the individual and small group markets. The covered benefits must include at least 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
AND MUCH MORE>…
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