Filed Under:Markets, Employee Benefits

Researchers track essential health benefits efforts

Meeting the new federal health benefits package standards for habilitative services may be complicated and confusing, but a need to add children's dental and children's vision care standards has been more common.

Sabrina Corlette and other Georgetown University health policy researchers have published that finding in a report distributed by the Urban Institute.

The researchers wrote the report to show how five states -- Alabama, Colorado, New Mexico, Oregon and Virginia -- are responding to the Patient Protection and Affordable Care Act "essential health benefits" package requirements.

The PPACA EHB provisions call for all nongrandfathered individual and small-group plans, inside and outside the public exchange system, to offer a standardized package of benefits starting Jan. 1.

The EHB benefits list includes some benefits that most individual and small-group major medical plans already offer, including coverage for outpatient care, emergency services, hospital care, laboratory services, and preventive care services.

The benefits package also includes benefits left out of some low-priced individual policies but usually included in small-group policies: Coverage for prescription drugs, maternity and newborn care, and mental health services.

In most states, those EHB requirements have had little effect on the commercial health insurance market, the researchers said.

In one state, Virginia, regulators did report a major market change, but they also reported seeing a significant expansion of benefits for individual policyholders, researchers said.

All but one of the five states studied had to add both pediatric dental and vision benefits to meet the EHB standard.

Only three of the states had to add standards for habilitative services -- rehabilitation-like services provided for individuals born without certain abilities, such as the ability to walk or the ability to talk. 

But PPACA and federal regulators did not set a definition for habilitative services, and some states have not come up with definitions, either, the researchers said.

"Some of our insurer respondents indicated they would just 'copy what we have on the physical therapy side' to comply with the requirement to cover habilitative services," the researchers said.

See also:

Originally published on BenefitsPro. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Featured Video

Most Recent Videos

Behind the scenes with Vicki Gunvalson [VIDEO]


In this exclusive interview, Vicki Gunvalson shares how she built a $15 million a year annuity business by planning for...

Regulator: Market may need to reinvent LTCI


Cioppa says Maine's governor wants to spur the creation of better products.

Dementia: It's more than Alzheimer's


An association calls for policymakers to remember lesser-known neurodegenerative conditions.

Protesters Disrupt WellPoint Annual Meeting


Hecklers call for more disclosures of information about political contributions.

Related resources

More Resources


Power your business with up-to-the-minute insurance news, analysis, and best practices from LifeHealthPro Daily eNewsletter – FREE.

Power your business with LifeHealthPro Daily eNewsletter – FREE.

Enter a valid email address.
Nichole Morford

Nichole Morford
Managing Editor

Thank you for subscribing to LifeHealthPro Daily!

Check Out More eNewsletters Now! Close

Advertisement. Closing in 15 seconds.