Kansas health plans might have to cover more services for children starting in 2014.
Consultants in the Denver office of Milliman Inc. raise that possibility in a report prepared for the Kansas Insurance Department.
Department officials asked Milliman to help them compare the existing Kansas health plans that might serve as the benchmark plan the state needs to choose to comply with the essential health benefits (EHB) provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
All of the 9 candidate plans offer similar benefits, and all fail to cover at least one of the benefits required by the PPACA EHB provision, the Milliman consultants say.
“All plans fail to fully cover habilitative services, as well as both pediatric oral and vision coverage,” the consultants say.
When Kansas uses the real-world plan it picks to be the model for the EHB package, it probably will have to add habilitative services, pediatric vision care and pediatric dental care benefits to the package, the consultants say.
All Kansas would have to do to flesh out the pediatric oral and vision benefits package would be to add benefits provided by a plan other than the EHB benchmark candidate plans, such as the Kansas Children’s Health Insurance Program, the consultants say.
Adding habilitative services benefits may take more work, the consultants suggest.
The EHB Program
If the law takes effect on schedule and works as drafters expect, it will require all individual and small group major medical plans to offer the standardized EHB package by 2014, to help consumers compare coverage and reduce gaps in coverage.
The U.S. Department of Health and Human Services (HHS) has asked each state to design its own EHB package. A state is supposed to start by looking at the benefits offered by the three largest Federal Employee Health Benefits Program plans offered in the state, the three largest state employee benefit plans, the three largest small group commercial health plans, and the largest commercial health maintenance organization (HMO) plan.