More From Health Net – Essential Health Benefits

As of January 2014 all plans must cover essential benefits. Open enrollment begins in October. Be prepared with the information relevant to you with Jordan Financial.

2014 Essential Health Benefits
All health plans offered in the individual and small group markets must provide a comprehensive package of items and services that are called Essential Health Benefits, which fit in 10 categories:
• Ambulatory patient services
• Emergency Services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services, and chronic disease management
• Pediatric services, including dental and vision care

The benefits generally will be based on those provided now in the small group market with some variation from state to state.
Wellness programs Permits employers to offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in a wellness program and meeting certain health-related standards.
If certain conditions are met, health plans may provide a discount or rebate when an individual satisfies a standard related to a health factor.

Affordable Care Protection In Place Today – Health Net

The Protections in place today according to Health Net include change that:

*Prohibits individual and group health plans from placing lifetime dollar limits on coverage.
*Restricts annual dollar limits on coverage for Essential Health Benefits.

Non-grandfathered plans must cover, without cost-sharing, a variety of preventive services as determined by organizations such as the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention.

Group and individual market health plans providing coverage for dependent children must continue to make coverage available for an adult child until the child turns 26 years of age.

Plans are prohibited from excluding from coverage children with pre-existing conditions who are under 19 years of age.

Plans covering emergency services must meet standards such as not requiring prior authorization, covering services from nonparticipating providers and not allowing out-of-network cost-sharing to exceed in-network rates.

Insurers and group health plans may not rescind an enrollee’s coverage unless the individual has performed an act that constitutes fraud against the plan or has intentionally misrepresented a material fact to the plan.
More On Grandfathered plans to come.

Leave a Reply

Your email address will not be published.