NC Insurance: Questions Surrounding the Health Insurance Reform

The health insurance reform is one of the most significant events currently taking place in the NC insurance world. The reform comes with a lot of changes (some good and some not so good) and a lot of questions. But one of the most important unknowns of the reform is currently being looked into by the Institute of Medicine.

What counts as an “essential health benefit?”

The health reform contains a law that states there is a set of essential health benefits that all insurance companies and plans must cover. Tomorrow, the Institute of Medicine will look into answering the question of what constitutes as an essential health benefit. The results of the recommendation that the institute comes up with will have a big impact on the whole health insurance industry. Why? Because any plan on the insurance marketplace will HAVE to cover whichever benefits the Institute labels as “essential.”

Also, the contents of the essential health benefits package may end up having implications on state budgets. States that mandate coverage in excess of the package will have to assume the cost of the additional benefits by making payments to either the individual enrolled in the qualified plans or directly to the qualified plans.

Currently there are 10 basic categories that must be included under the essential health benefits package. According to HealthCare.gov these requirements include, “ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.” The Institute of Medicine is only the next step in specifying what an “essential health benefit” really is.

However, the Institute’s decision will not be the final step in determining which essential health benefits will be included in all insurance plan. Next on the timeline will be officials issuing a ruling at the end of the year and taking consumer and insurer comments on that ruling. The final rule likely won’t be available until at least May of 2012.

To stay up to date on the latest happenings in the insurance world and for more information on NC insurance, visit our website or call Spivey Insurance Group today at 877-318-5951 to speak to one of our friendly agents!

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