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State's Freedom To Create Exchanges Come With Conditions

01/03/12

Permalink 02:52:20 pm, by MedBen5 Email , 230 words, 1040 views   English (US)
Categories: News, Health Plan Management

State's Freedom To Create Exchanges Come With Conditions

Last month, the Obama administration announced that states will have greater flexibility to determine benefits available through their health insurance exchanges under the Affordable Care Act. But just how much latitude will the federal government allow? Stateline provides some clarification:

“Not total freedom, by any means. The national health law lists 10 categories of health care that all insurance policies must cover: hospitalization, emergency care, out-patient services, maternity and newborn care, mental health and substance abuse services, prescription drugs, laboratory testing, preventive and wellness care, pediatric services (including dental and vision examinations), rehabilitative care and habilitative care such as services for children with developmental disabilities.

“But within those categories, the federal government is allowing each state to determine its own basket of essential benefits by choosing a ‘benchmark’ package offered by any of a variety of insurers. They can pick from:

  • One of the three largest (by enrollment) small group plans in the state;
  • One of the three largest state employee health plans;
  • One of the largest federal employee health plan options;
  • The largest HMO plan offered in the state’s commercial market

“If a state does not select any of these, the largest plan in the small group market will be the default. If a state selects a benchmark which does not cover one or more of the 10 required categories, it would need to ’supplement’ the benchmark to include all 10.”

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