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BenefitsLink Health & Welfare Plans Newsletter

Supplement to
February 20, 2013
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BULLETIN

Supplement to February 20, 2013

 

[Official Guidance]

Text of Final Regs on ACA Standards Related to Essential Health Benefits, Actuarial Value and Accreditation (PDF)
"This final rule sets forth standards for health insurance issuers consistent with [the ACA]. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans." (Department of Health and Human Services)

[Official Guidance]

Text of FAQs on ACA Implementation, Part XII
The set of 20 Q&As basically covers (1) limitations on cost-sharing, and (2) coverage of preventive services. Excerpt: "[P]lans and issuers are prohibited from imposing an annual out-of-pocket maximum on all medical/surgical benefits and a separate annual out-of-pocket maximum on all mental health and substance use disorder benefits.... While nothing in the interim final regulations generally requires a plan or issuer that has a network of providers to provide benefits for preventive services provided out-of-network, this provision is premised on enrollees being able to access the required preventive services from in-network providers. Thus, if a plan or issuer does not have in its network a provider who can provide the particular service, then the plan or issuer must cover the item or service when performed by an out-of-network provider and not impose cost-sharing with respect to the item or service.... The HRSA Guidelines recommend at least one annual well-woman preventive care visit for adult women to obtain the recommended preventive services that are age- and developmentally-appropriate, including preconception and prenatal care.... If the clinician determines that a patient requires additional well-woman visits for this purpose, then the additional visits must be provided in accordance with the requirements of the interim final regulations (that is, without cost-sharing and subject to reasonable medical management)." (Department of Health and Human Services; Department of Labor; Department of the Treasury)

[Guidance Overview]

HHS Announces Final ACA Regs Allowing Consumers to 'Easily Find and Compare Options Starting in 2014'
"Today's rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans." (Centers for Medicare & Medicaid Services)

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