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April 2, 2023

Essential Health Benefits-What Do You Want vs. What Are You Willing To Pay?

Essential Health Benefits-What Do You Want vs. What Are You Willing To Pay?

by Eric Smith / Wednesday, 26 September 2012 / Published in Colorado State Initiatives, Federal Law Changes and Mandates, Personal Observation

The Affordable Care Act requires Americans have access to quality, affordable health insurance. To achieve this goal, the law requires health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.”  Essential health benefits must include items and services within at least the following 10 categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

The challenge now facing the Colorado Department of Insurance is what additional, if any, benefits they will require the new policies to contain. Each state is empowered to devise their own list.

Here is a partial run down of additional requirements being consider in other states and of course, each benefit has a very active advacacy group pushing for inclusion:

Acupuncture (now a requirement in California)

Chiropractic care

Pre-vacation visits to travel clinics (whatever this is, apparently it will be required in Colorado)

Fertility treatments

Speech therapy

Bariatric Surgery (stomach reduction)

Each of these services is, of course, very dear to a segment of the population. The question before the Department of Insurance is “is it reasonable to require all health insurance policy holders to pay higher premiums for these benefits, when they may or may not be “”essential””?

Here is an excellent article written by the Washington Post on this subject.

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Tagged under: 2012, Affordable Care Act, Colorado State Laws, Federal Mandates

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