Healthcare Reform Law – Benefits and PlansThere have been numerous parts of the Healthcare Reform Law (PPACA) implemented since it was signed into law on March 23, 2010. But the parts that will have the largest impact on every citizen will take effect January 1, 2014. Over the next few issues of my newsletter I will highlight these important pieces.
Essential Health Benefits (EHB)
Non-grandfathered individual and small group plans offered inside and outside of exchanges must provide certain benefits. The PPACA specified a list of 10 service categories that must be included in the plans. These are:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
The law does not define the specific benefits to be covered under each service category. That task fell to the Department of Health and Human Services (HHS) and those definitions are being finalized.
Levels of Coverage – Metal Plans
The PPACA also requires that the EHB package is offered at 4 levels of coverage. They are also referred to as the “metal plans.”
- Platinum – Actuarial Value of 88% – 92%
- Gold – Actuarial Value of 78% – 82%
- Silver – Actuarial Value of 68% – 72%
- Bronze – Actuarial Value of 58% – 62%
For example, a plan with an actuarial value of 70% would be a silver plan. This means that on average the plan will pay 70% of enrollee health care expenses while enrollees will pay 30% through some combination of deductibles, copays and coinsurance.
In upcoming newsletters I will review the introduction of Exchanges as well as the Individual Mandate.
Please note that along with health insurance products, I also work with many employer groups on Voluntary Worksite Products. And I am also certified to assist individuals with Long Term Care plans.
Thank you for your time and the opportunity to work with you on your insurance needs.