Researchers track essential health benefits efforts

Meeting the new federal health benefits package standards for habilitative services may be complicated and confusing, but a need to add children’s dental and children’s vision care standards has been more common.

Sabrina Corlette and other Georgetown University health policy researchers have published that finding in a report distributed by the Urban Institute.

The researchers wrote the report to show how five states — Alabama, Colorado, New Mexico, Oregon and Virginia — are responding to the Patient Protection and Affordable Care Act “essential health benefits” package requirements.

The PPACA EHB provisions call for all nongrandfathered individual and small-group plans, inside and outside the public exchange system, to offer a standardized package of benefits starting Jan. 1.

The EHB benefits list includes some benefits that most individual and small-group major medical plans already offer, including coverage for outpatient care, emergency services, hospital care, laboratory services, and preventive care services.

The benefits package also includes benefits left out of some low-priced individual policies but usually included in small-group policies: Coverage for prescription drugs, maternity and newborn care, and mental health services.

In most states, those EHB requirements have had little effect on the commercial health insurance market, the researchers said.