Perspectives on essential health benefits : workshop report /

• Corporate Authors: Institute of Medicine (U.S.) Board on Health Care Services, Institute of Medicine (U.S.) Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans
• Other Authors: Ulmer, Cheryl (Editor), McFadden, Bernadette (Editor), Cacace, Cassandra (Editor)
• Format: Book
• Language: English
• Published: Washington, D.C. National Academies Press 2012
• Subjects: United States > Patient Protection and Affordable Care Act; State Health Plans > Congresses > economics > United States; Insurance, Health > Congresses > economics > United States; Insurance Benefits > Congresses > standards > United States; Insurance Benefits > Congresses > economics > United States
• Online Access: Click Here to View Status and Holdings.

The Patient Protection and Affordable Care Act (herein known as the Affordable Care Act [ACA]) was signed into law on March 23, 2010. Several provisions of the law went into effect in 2010 (including requirements to cover children up to age 26 and to prohibit insurance companies from denying coverag...

Table of Contents:

• Introduction
• The policy context for essential health benefits
• Purchaser perspectives on the EHB
• State experiences with defining a minimum benefit standard
• Medical necessity and use of evidence
• Insurer decisions of benefit coverage and medical necessity
• Examining two categories of care in section 1302
• Non-discrimination in the required elements for consideration
• Additional stakeholder perspectives
• Two private-sector approaches to benefit coverage and design
• Deciding what is essential and evidence-based in two states for public insurance programs
• Lessons from California's benefit review process
• Priority setting and value-based insurance design
• Assessing affordability and the potential for underinsurance.