As promised, I said I'd post my questions or clarifications to the HCR bill as I understood more about what I read in the bill. So, here's my first Q & A/C issue ("Q" = Question obviously, and the "A/C" = Answer or Clarification):
C: Under Div A, Title I, sec. 102(a), all individuals who have health care insurance by the first day this bill is enacted (in year-1 (Y1), "2013") will retain their current health insurance. But if you go down and read subparagraph (b)(1)(A) "Grace Period", it reads:
In general, the Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1 (=20130), an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefits package requirement under section 121.
What does sec. 101 say as it applies to the above is:
Sec. 101 - Requirements for Qualified Health Benefits Plans: On or after the first day of Y1 (2013), a health benefits plan shall not be a qualified health benefits plan under this division ("A" to Title I) unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year invovled:
(1) Subtitle B - relating to affordable coverage
(2) Subtitle C - relating to essential benefits
(3) Subtitle D - relating to consumer protection
Subtitle B essentially states that no person shall be excluded or denied health care for pre-existing conditions nor should they be discriminated against on the grounds of their sex, race, or religious preference and that health insurance should be fairly and competitively priced.
Subtitle C is actually the sticking point. I'll get to why I beleive so in a moment.
Subtitle D essentially outlines how payments can be made using debit cards as a option to paying for medical cost, that grievances shall be handled fairly and impartially and that information concerning health insurance coverage shall be made available using the best means possible, i.e., the Internet, "plain language", and translated into other languages as necessary. (Though the later linguistic take isn't stated definatively that way, it's not hard to conclude that what it means is insurance information should also be marketed in Spanish or any other languange necessary for the individual police holder to understand it).
Now, back to Subtitle C. Here's how it reads:
A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the "essential benefits package" described in section 122 for the plan year involved.
Well, now you have to know what section 124 and 122 say. So...
Section 124 essentially outlines how the Secretary (of Health & Human Services) will be adopt new or improved health care standards, if any. He can approve (adopt) them or disapprove them.
Section 122 essentially lifts a few of the restrictions we currently face in today's health care system, such as limiting annual benefits such as one or two dental cleanings per year for example, or restricting coverage of some benefits such as wellness and well-baby care. Such care would come under "essential health care" and make them more accessible and affordable. In-home care would also be covered, as well as, the equipment and services received for in-home care. Covered care (sec. 122(b)) would include:
- Hospitalization
- Outpatient hospital/clinic services
- Emergency room services
- Professional services by your physician
- Health services equipment & supplies utilized for health care including in-home treatment and "institutionalized care" (i.e., nursing home care).
- Prescription drugs
- Rehab treatment
- Mental health care
- Substance abuse/use disorder
- Preventive services
- Maturity care (including well-baby and well-child care)
- Dental (oral) health care
- Vision Care
- Hearing services, equipment and supplies
Essentially, anyone under the age of 21 who has health care will receive these benefits either under their current health care plan (as adopted by the Health Choices Administration) or if they chose to obtain health care coverage under the Health Insurance Exchange (public option) program.
Q: Per sec 122(c)(2)(B), the annual allowable limits for health care coverage under the HCR bill would be $5,000 per individual and $10,000 for families. However, these cost limits apply only to those expenses that come under "reference benefit packages" provided that there is no cost-sharing involved. Got it? Neither did I. So, my question to those who are in the health care industry is this: What exactly is a reference benefits package and how does cost-sharing fit into it as it applies to insurance coverage?
