Essential Health Benefits Balancing Coverage and Cost (2012) / Chapter Skim
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Appendix A: Patient Protection and Affordable Care Act, Section 1302, and Web Questions for Public Input
Appendix A: Patient Protection and Affordable Care Act, Section 1302, and Web Questions for Public Input
Pages 153-158
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From page 153... ...
(a) ESSENTIAL HEALTH BENEFITS PACKAGE. -- In this title, the term "essential health benefits package" means, with respect to any health plan, coverage that -- (1)
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From page 154... ...
ensure that health benefits established as essential not be subject to denial to individuals against their wishes on the basis of the individuals' age or expected length of life or of the individuals' present or predicted disability, degree of medical dependency, or quality of life; (E) provide that a qualified health plan shall not be treated as providing coverage for the essential health benefits described in paragraph (1)
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From page 155... ...
(5) RULE OF CONSTRUCTION. -- Nothing in this title shall be construed to prohibit a health plan from providing benefits in excess of the essential health benefits described in this subsection.
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From page 156... ...
(C) APPLICATION. -- In determining under this title, the Public Health Service Act, or the Internal Revenue Code of 1986 the percentage of the total allowed costs of benefits provided under a group health plan or health insurance coverage that are provided by such plan or coverage, the rules contained in the regulations under this paragraph shall apply.
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From page 157... ...
The 10 categories are ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorders services, includ ing behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; pediatric services, including oral and vision care. How could it be determined that essential benefits are "not subject to denial to individuals against their wishes" on the basis of age, expected length of life, present or predicted disability, degree of medical dependency, or quality of life?
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