Feds outline what insurers must cover

Feb 22 2013

The final rule on essential health benefits, issued yesterday, defines what must be covered in health plans sold in online marketplaces beginning this fall, including prescription benefits and mental health services, and prohibits discrimination based on age or pre-existing medical conditions.

The Wall Street Journal: Health-Plan Details Unveiled
Health-insurance plans that cover tens of millions of Americans will have to pay for mental-health and substance-abuse treatments starting next year under federal rules the Obama administration finalized Wednesday. The provision, part of the 2010 Affordable Care Act, requires health plans for individuals and small businesses to cover 10 categories of services, including prescription drugs, maternity care and physical rehabilitation. Many of the specifics of what is covered in those categories will be left to states to decide (Dooren, 2/20).

USA Today: HHS Releases Rule On Insurers' Essential Health Benefits
The rule defines what must be covered in exchange plans, prohibits discrimination based on age or pre-existing conditions, describes prescription drug benefits and determines levels of coverage (Kennedy, 2/20).

Kaiser Health News: Capsules: Feds Outline What Insurers Must Cover, Down To Polyp Removal
Essential benefit requirements apply mainly to individual and small group plans. They also apply to plans provided to those newly eligible for Medicaid coverage. A few provisions also affect self-insured plans and large group plans offered by employers (Appleby, 2/20).

The New York Times: New Federal Rule Requires Insurers To Offer Mental Health Coverage
The Obama administration issued a final rule on Wednesday defining "essential health benefits" that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result (Pear, 2/20).

The Associated Press: Obama Administration Tackles Colonoscopy Confusion
It's one part of the new health care law that seemed clear: free coverage for preventive care under most insurance plans. Only it didn't turn out that way. So on Wednesday, the Obama administration had to straighten out the confusion. Have you gone for a colonoscopy thinking it was free, only to get a hefty bill because the doctor removed a polyp? No more. Taking out such precancerous growths as part of a routine colon cancer screening procedure will now be considered preventive care (Alonso-Zaldivar, 2/20).

Reuters: U.S. Issues Final Word On Essential Benefits Under "Obamacare"
The Obama administration on Wednesday issued its long-awaited final rule on what states and insurers must do to provide the essential health benefits required in the individual and small-group market beginning in 2014 under the healthcare reform law. A cornerstone of President Barack Obama's plan to enhance the breadth of healthcare coverage in the United States, the mandate allows the 50 U.S. states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal healthcare exchanges (Morgan, 2/20).

The Hill: New Healthcare Rule Expands Benefits For Substance Abuse, Mental Disorders
The Obama administration on Wednesday finalized a key Affordable Care Act rule predicted to expand substance abuse and mental disorder benefits to 62 million Americans. The rule, to take effect next year, lays out new "essential health benefits" standards for insurers, as required by the landmark legislation. It was designed to allow consumers a simplified and consistent way to shop for, and enroll in, healthcare plans that best suit them (Goad, 2/20).