This morning, I read an article on amednews.com that made my head hurt. Since misery loves company, and since the focus of the article affects the future of your health plans, I wanted to share it with you.
The article detailed the complexity facing the Institute of Medicine panel that is charged with recommending to the Health and Human Services Department what should be in the “essential benefits” package that is mandated by the Patient Protection and Affordable Care Act.
The panel has to craft a package that is comprehensive — covering necessary medical services for children, women, seniors and other niche groups across 10 service categories — without being so rich that it’s too expensive, and figure out how to incorporate insurer demands to be allowed to apply “medical necessity” standards when approving or denying care.
As if that weren’t difficult enough, the entire package has to maintain a level of care that’s on par with a “typical employer plan.”
Well, what in the hay is a “typical” employer plan?
According to the article, the IOM panel will try to balance “typical” with “essential” through June, and aims to make its recommendations to HHS in September — which will make for a very interesting summer.
Til then, share your thoughts in the comments: What, in your view, is a typical employer plan? What services should be deemed “essential?” And how do you think HHS’ ultimate decision affect the health benefits you offer?
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