Health News
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that states would decide what essential health benefits will be provided under health care reform. Although we had urged HHS to adopt a uniform, national benefits floor that states could build on, the federal proposal offers important flexibility for states. (Check out our essential health benefits archive.)
So, what does the essential health benefits announcement mean for people with HIV? The short answer is that we?re working on it. Here are some of the hoops we?ll have to jump through just to figure out what the benefits might look like in a state.
Which plans are we talking about? HHS gives states the choice of:
(1) the largest plan by enrollment in any of the three largest small group insurance products in the State?s small group market;
(2) any of the largest three State employee health benefit plans by enrollment;
(3) any of the largest three national FEHBP [Federal Employee Health Benefit Plan] plan options by enrollment; or
(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.
Yeah, we weren?t sure where to start either. There?s no centralized federal repository of health plan data, since states regulate health insurance. Every state publishes plan information online differently, or not at all. We?ll probably have to submit a special data request to each of the 50 state insurance departments.
What benefits does each plan offer? Once advocates identify the largest plans, the next step is to determine exactly what benefits they offer. You can bet that Blue Cross doesn?t publish on their website a description of each of their hundreds of plans offered in a state. We?ll might have to ask companies directly for plan descriptions, or pour through regulatory filings at state insurance departments.
Once we have this information, we can start to figure out what the plans will look like for people with HIV. Of course, we?ll partner with national and state advocates to gather and analyze information. At the state level, it?s more essential than ever that advocates work together to figure out the benefit puzzle and don?t duplicate effort.
And here?s an idea: Could advocates, employers and insurance companies collaborate to gather all this information? Sure, old adversaries would have to sit at the same conference table to share opinions and information ? but that might be just ?what the doctor ordered? in the new world of health care.
Read the federal fact sheet
Read the HHS Essential Health Benefits Bulletin
Federal white paper on benefits in small group and state and federal plans
Federal fact sheet on individual market benefits
- Anthem Ppo Plan Chosen As 'benchmark' For State's Kentucky Health Benefit Exchange
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- Illinois Entrepreneurs And Small Business Need Shop Employee Choice
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- Illinois Essential Health Benefits Benchmark Plan
The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan. This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits"...
- Illinois Begins Essential Health Benefits Discussion
Governor Pat Quinn recently announced that the benchmark plan for Illinois? Essential Health Benefits (EHB) package will be chosen by September 30, in order to meet the Federal deadline for selecting a plan. A public meeting on Wednesday, September 12th,...
Health News
Essential Health Benefits: What?s it mean for people with HIV?
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that states would decide what essential health benefits will be provided under health care reform. Although we had urged HHS to adopt a uniform, national benefits floor that states could build on, the federal proposal offers important flexibility for states. (Check out our essential health benefits archive.)
So, what does the essential health benefits announcement mean for people with HIV? The short answer is that we?re working on it. Here are some of the hoops we?ll have to jump through just to figure out what the benefits might look like in a state.
Which plans are we talking about? HHS gives states the choice of:
(1) the largest plan by enrollment in any of the three largest small group insurance products in the State?s small group market;
(2) any of the largest three State employee health benefit plans by enrollment;
(3) any of the largest three national FEHBP [Federal Employee Health Benefit Plan] plan options by enrollment; or
(4) the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.
Yeah, we weren?t sure where to start either. There?s no centralized federal repository of health plan data, since states regulate health insurance. Every state publishes plan information online differently, or not at all. We?ll probably have to submit a special data request to each of the 50 state insurance departments.
What benefits does each plan offer? Once advocates identify the largest plans, the next step is to determine exactly what benefits they offer. You can bet that Blue Cross doesn?t publish on their website a description of each of their hundreds of plans offered in a state. We?ll might have to ask companies directly for plan descriptions, or pour through regulatory filings at state insurance departments.
Once we have this information, we can start to figure out what the plans will look like for people with HIV. Of course, we?ll partner with national and state advocates to gather and analyze information. At the state level, it?s more essential than ever that advocates work together to figure out the benefit puzzle and don?t duplicate effort.
And here?s an idea: Could advocates, employers and insurance companies collaborate to gather all this information? Sure, old adversaries would have to sit at the same conference table to share opinions and information ? but that might be just ?what the doctor ordered? in the new world of health care.
Read the federal fact sheet
Read the HHS Essential Health Benefits Bulletin
Federal white paper on benefits in small group and state and federal plans
Federal fact sheet on individual market benefits
John Peller, VP of Policy
AIDS Foundation of Chicago
[email protected]
AIDS Foundation of Chicago
[email protected]
Originally posted here on HIVHealthReform.org
- Anthem Ppo Plan Chosen As 'benchmark' For State's Kentucky Health Benefit Exchange
The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the ?benchmark? plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued...
- Illinois Entrepreneurs And Small Business Need Shop Employee Choice
Illinois is one of 18 states recently granted a delay by the Department of Health and Human Services for the employee choice feature of the small business health options program marketplace, or SHOP. But what exactly is employee choice, and why is this...
- Clearing Up The Facts
There has been a lot of confusion about some recent notices to consumers from insurance companies that sell coverage in the individual insurance market, and I?d like to clear up the facts. Today, more than 3 out of every 4 Americans get insurance from...
- Illinois Essential Health Benefits Benchmark Plan
The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan. This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits"...
- Illinois Begins Essential Health Benefits Discussion
Governor Pat Quinn recently announced that the benchmark plan for Illinois? Essential Health Benefits (EHB) package will be chosen by September 30, in order to meet the Federal deadline for selecting a plan. A public meeting on Wednesday, September 12th,...