AHIP: No specific essential benefits needed for health exchanges

Health insurance exchanges shouldn't require specific essential items or services that must be included in health plans, AHIP told the Institute of Medicine, which is responsible for recommending to HHS essential health benefits required under the health reform law.

The 10 general categories of benefits outlined in the reform law already specify an "appropriate set" of items or services that should be included in the essential health benefits package, The Hill’s Healthwatch reports.

"Broadening the scope of the essential health benefit package could have the unintended consequence of making products unaffordable and thereby limit access and consumer choice," says Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, according to National Underwriter.

AHIP also said the essential benefits package should not force individuals and small employers to purchase a richer scope of benefits than what is currently available today. The IOM should recommend an essential benefits system that allows for plans to vary levels of co-payments, deductibles and coinsurance within different benefit categories, notes Healthwatch.

One way regulators can help small employers is to define "typical employer plan" in a way that acknowledges the distinctions between different market segments, such as large groups and small groups, Bocchino said.

Regulators also should keep the existing state health benefits mandates out of the essential health benefits package. "Currently, there exist more than 2,000 state mandates," Bocchino said. "It would be impossible to include this large number of existing mandates in a national essential benefit package while at the same time providing affordable access to care for consumers."

To learn more:
- read The Hill’s Healthwatch story
- see the National Underwriter article

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