Essential Health Benefits Balancing Coverage and Cost (2012) / Chapter Skim
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Appendix D: Examples of Benefit Package Statutory Guidance
Appendix D: Examples of Benefit Package Statutory Guidance
Pages 191-196
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From page 191... ...
Appendix D Examples of Benefit Package Statutory Guidance This appendix includes a display of benefit categories in statute for various health insurance programs.
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Maryland Massachusetts Exchange Year Created 1959 1965 1965 1975 1993 2006 Categorization Service Benefit Part A Mandatory Services Basic Health Care Comprehensive Minimum Creditable of Benefits Plan Services Standard Health Coverage Standards Benefit Plan (CSHBP) • Hospital benefits • Inpatient hospital • Physician services • Hospital inpatient • Ambulatory patient • Surgical benefits • Skilled nursing facility • Lab and X-ray services • Ambulance service services (including • In-hospital medical • Home health services • Physician services • Audiology screening outpatient day surgery benefits • Hospice • Inpatient hospital • Outpatient and for newborns and related anesthesia)
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From page 193... ...
Maryland Massachusetts Exchange • Preventive services rated by the U.S. Preventive Services Task Force as A or B not subject to deductible and no cost sharing if provided in-network • Skilled nursing facility • Transplants • Well child and immunization benefits Indemnity Benefit Part B Plan • Hospital care • Physician and other • Surgical care and medical services treatment • Outpatient hospital • Medical care and care treatment • Ambulatory surgical • Obstetrical benefits services • Prescribed drugs, • Diagnostic tests, medicines, and x-rays, and lab prosthetic devices services • Other medical • Durable medical supplies and equipment services • Physical, occupational, and speech therapy • Clinical laboratory services • Home health care • Outpatient mental health services • One-time "Welcome to Medicare" physical exam • Preventive servicesa 193 continued
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Part D • Prescription Drugs Optional Services • Medical care, • Outpatient prescription remedial care drugs [42.7, Rule by licensed 300.67.24] practitioners • Chiropractic services • Prescription drugs • Dental care • Diagnostic, • Hearing aids screening, preventive, and rehabilitative services • Clinic services • Primary care case management • Dental services and dentures • Physical therapy • Prosthetic devices and eyeglasses • Tuberculosis-related services • Other specified medical and remedial care • Intermediate care facility for the mentally retarded (ICF/MR)
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From page 195... ...
; limit of one flu shot per flu season; hepatitis B shot, colorectal and prostate cancer screening, pap smear, mammogram, cardiovascular screening, abdominal aortic aneurysm (AAA) screening, bone mass measurement, diabetes screening and monitoring, glaucoma screening, smoking cessation.
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From page 196... ...
2011. Knox-Keene Health Care Service Plan Act of 1975.
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