Bernard DiFiore Addresses Essential Benefits to HHS
BenefitMall’s President and Chief Executive Officer, Bernard DiFiore, met with the Department of Health and Human Services (HHS) today in Dallas to address the topic of essential health benefits. HHS has set up a series of meetings across the United States to hear from invited healthcare stakeholders to learn about the different needs and expectations for establishing specific criteria for essential health benefits before final recommendations are written.
Essential health benefits are the required categories of coverage health plans must provide beginning in 2014. The Affordable Care Act defines essential health benefits to “include at least the following general categories and the items and services covered within the 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; and pediatric services, including oral and vision care.''
Based on BenefitMall's extensive database of sold coverages across the United States, DiFiore reported to HHS that the actual scope and cost of benefits offered by small businesses today is significantly less than what is expected to be mandated in 2014. Benefits and costs vary significantly by geographical region, thus further complicating a national standard.
Representatives from HHS are aware of many of the issues presented by the attendees at the meeting and appreciate their input. The process of defining essential benefits is extremely difficult given the expansive availability of care and the limits of cost.
DiFiore also noted that "It is important to find a successful balance between providing affordable coverage while establishing a reasonable level of benefit protection. If we continue to increase the cost by mandating a comprehensive set of essential benefits, we place further unwanted burdens on the business owner and their employees."
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