Pro s a nd Co ns o f Cha ng ing the ACA s E sse ntia l He a lth - - PowerPoint PPT Presentation

Pro s a nd Co ns o f Cha ng ing the ACA’ s E sse ntia l He a lth Be ne fit Re q uire me nt

MODE RAT OR: AUDRE Y SHE L T O PRE SI DE NT , BCBSMA F OUNDAT I ON

E sse ntia l He a lth Be ne fits Re q uire me nt

 All pla ns so ld in ind ivid ua l a nd sma ll g ro up ma rke ts, must

inc lud e a t le a st 10 E sse ntia l Be ne fits.

 E

a c h q ua lifie d pla n must o ffe r e sse ntia l he a lth b e ne fits whic h o ve ra ll a re e q ua l to the sc o pe o f b e ne fits typic a lly c o ve re d b y e mplo ye rs (b e nc hma rk pla n).

E sse ntia l He a lth Be ne fits De finitio n

 Amb ula to ry pa tie nt

se rvic e s

 E

me rg e nc y se rvic e s

 Ho spita liza tio n  Ma te rnity a nd ne wb o rn

c a re

 Me nta l he a lth a nd SUD

se rvic e s

 Pre sc riptio n d rug s 

Re ha b & ha b ilita tive c a re & d e vic e s



L a b se rvic e s

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Pre ve ntive & we llne ss se rvic e s & c hro nic d ise a se ma na g e me nt

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Pe d ia tric se rvic e s, inc lud ing o ra l a nd visio n c a re