Here it comes whether we are ready, trained, or able to talk in complete sentences. The Affordable Care Act is a reality, so we should at least know what we are going to buy. I say we because although I will be selling it as an agent, I will also be purchasing it as a consumer.
So let’s get started. What are the “TEN ESSENTIAL BENEFITS”, that are required for a plan to be considered a “Qualified Plan”, and be sold on the “Exchange”?
1) Ambulatory Patient Services
– Care received outside of a Hospital, Dr.’s office, walk-in clinic, same day surgery.
2) Emergency Care
– Care for conditions that if not treated immediately could lead to serious health conditions and possible death.
– Care in a hospital (including but not limited to surgery, drugs, room and board, tests and such).
4) Maternity and Newborn Care
5) Mental Health and Substance Abuse Disorder Services
– This includes behavioral treatment. This is for evaluation, diagnosis and treatment of mental health and substance abuse.
6) Prescription Drugs
– Drugs for ongoing treatment as well as acute illness that require a doctor’s prescription.
7) Rehabilitative and Habilitative Services and Devices
– This is for rehab to relearn skills, e.g. talking, walking, feeding oneself, or motor skills, and rebuilding strength and flexibility. Habilitative services are for keeping and learning age appropriate skill and increased functioning. Unfortunately this is a very broad definition and leaves some gray area for consideration.
8) Lab services
– Testing to diagnose a medical condition or to monitor an ongoing treatment.
9) Preventative and Wellness services
– Including chronic disease management, routine physicals screening and immunizations. Chronic disease management is an integrated approach to manage ongoing chronic conditions.
10) Pediatric service for children under 19
These services also include dental services for children under 19, preventative and restorative care as well as vision care and prescription eye glasses for children.
The key to all of this is these are broad sweeping benefit definitions. The insurance companies can submit programs that fit into the various metal levels (bronze, silver, gold etc) for actuarial coverage.
With that said we will have more and better information to your e-mail as soon as we know, until then please be patient and tell a friend about our services, the more people that know, the more people we can help walk through this maze of information.