At this point, employers may be intimately familiar with many of the provisions of the Affordable Care Act – coverage until age 26, no exclusions for pre-existing conditions and others. But one clause that may have escaped the attention of benefit managers relates to experimental treatments and medications – if you weren’t covering clinical trials, odds are you might have to now.
Starting next year, the health care reform act holds that a “qualified individual” cannot be denied coverage by a plan for “related services” from an approved clinical trial. While that by itself may not mean deep changes for most employer-sponsored health care plans, many of those medical studies say they will cover related expenses that aren’t already taken care of by existing insurance – a convergence-of-care issue for even well-designed plans.
