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Advisory Panel Releases 'Essential Benefits' Report

The Institute of Medicine (IOM) released its report of recommendations to the United States Department of Health and Human Services regarding what health benefits should  be provided by insurance plans under the Health reform law – the Affordable Care Act (ACA).   The ACA requires states to set up an health insurance market place or exchange by 2014 to allow for the selling of insurance to individuals and small employers. The law requires that insurance companies who want to sell their plans in the exchange offer certain ‘essential benefits’ classified into ten categories some of these categories include: hospital and emergency services, prescription drugs, childbirth and pediatric care.

IOM’s report lays out a methodology that should be used to determine ‘essential health benefits’.  The report also emphasized that the benefit package should be affordable based on the average cost of health insurance for small employers in 2014 – when exchanges should be fully implemented. The government should announce their final plan by May 1, 2012 and will hold a series of listening sessions across the country.  Listed below is the IOM report and additional resources.

Institute of Medicine: Essential Health Benefits: Balancing Coverage and Cost

Implementing Health Insurance Exchanges: State Profiles

Kaiser Family Foundation – What is a Health Insurance Exchange?

State Action Towards Creating a Health Insurance Exchange, as of September 23, 2011

Establishing Health Insurance Exchanges: An Update on State Efforts

Implementing Health Insurance Exchanges: State Profiles

Health-care law benefits must be limited to ensure affordability, panel says

Panel Says U.S. Should Weigh Cost in Deciding ‘Essential Health Benefits’

HFA Comment Letter to Institute of Medicine on Essential Health Benefits December 2010

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