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Learn about Essential Health Benefits (EHB) Benchmark Plans
Information on Essential Health Benefits (EHB) Benchmark Plans
Understanding Essential Health Benefits Benchmark Plans
Let’s delve into the world of healthcare and unpack the concept of Essential Health Benefits (EHBS) Benchmark Plans. These plans are a standard, state-determined set of health care service categories that must be covered by certain plans. They become an important part of the discussion when understanding health insurance coverage, particularly under the Affordable Care Act (ACA).
A framework for defining what benefits exactly fall under the EHB benchmark was created in a bid to create a comprehensive package of items and services. These plans provide a clearer, more concrete illustration of what insurers are required to cover within their health insurance policies.
The types of health services covered under EHB benchmark plans range from ambulatory patient services to laboratory services. There’s really a broad array of medical fields these cover, making them essential for any person keen on getting extensive healthcare coverage.
To make this a bit more palpable, let’s look at a case from Kentucky:
In selecting the EHB-benchmark plan, Kentucky chose Anthem’s PPO, the largest small-group plan in the state. The following are the basics of the benefits included in this plan:
- Ambulatory Patient Services
- Emergency Services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription Drugs
Federal Requirements for EHB Benchmarks
While states have some leeway in determining their EHB-benchmark plan, they still need to adhere to federal guidelines. These requirements stipulate ten categories that must always be part of every EHB-benchmark plan. This ensures a basic level of widespread coverage across all plans.
These federal requirements not only give states a bit of direction but also act as safety nets for policyholders. No insurer can provide a plan lacking any of these categories. As a result, policyholders are assured quality care across multiple fields.
As our focus now turns to what exactly these mandatory categories entail, a broader understanding of the scope of these EHB-benchmark plans starts to emerge. These requirements paint a picture of governmental efforts to provide comprehensive medical coverage for all.
Washington State serves as an apt illustration. The Kaiser Foundation Health Plan of Washington was chosen as its EHB-Benchmark Plan and includes:
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
- Rehabilitative and habilitative services and devices
- Laboratory services
- Emergency services
- Hospitalization
An Overview of EHB Provision Categories
Following from the previous segment, these mandated categories can be broken down further. This gives more insight into the kinds of care and services these EHB benchmark plans cover.
(Remember: Your specific needs and circumstances will dictate which categories carry more weight.)
By doing so, anyone can form a well-informed perspective on whether a certain health insurance policy will suffice or not. The ultimate goal is to attain a heightened degree of healthcare service satisfaction and enjoy better health.
In line with this subject matter, let’s use Florida’s Blueprint Health Maintenance Organization Plan. Here are six major categories in the plan:
- Ambulatory patient services
- Mental health and substance use disorder services
- Prenatal and postnatal care
- Prescription drugs
- Pediatrics
- Wellness & Disease Management
A Glimpse into Costs Associated with EHB Plans
The costs associated with EHB benchmark plans can be quite complex. For instance, there are out-of-pocket costs such as copayments, coinsurance, and deductibles to consider. Furthermore, the policy premiums also vary depending on several factors.
Bear in mind that federally managed programs like Medicaid and CHIP provide insurance coverage at lower costs or even for free. Hence, individual financial circumstances largely dictate what kind of a deal one gets.
Looking to illustrate this point we’ll use Texas as an illustration. The Texas EHB-Benchmark Plan includes:
- Office Visit, Physician – you pay $30 per visit
- Outpatient Mental / Behavioral Health – you pay 20% after deductible
- Inpatient Hospital Services – you pay 20% after deductible
- Generic Drugs – you pay $10
- Diagnostic Lab – you pay 20% after deductible
- Routine Eye Exam (Pediatric) – you pay $40 per visit
In conclusion, understanding Essential Health Benefits Benchmark Plans plays a crucial role in making informed healthcare decisions. Remember, choosing the right insurance plan contributes significantly to maintaining your health and managing unexpected illnesses.
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| Understanding Essential Health Benefits Benchmark Plans | Kentucky’s Anthem PPO |
| Federal Requirements for EHB Benchmarks | Kaiser Foundation Health Plan of Washington state|
| An Overview of EHB Provision Categories | Florida’s Blueprint Health Maintenance Organization Plan |
| A Glimpse into Costs Associated with EHB Plans | Texas EHB-Benchmark Plan |