HCW Benefits Blog

Contributor:
Chris Tutino, Communications Specialist
Hill, Chesson & Woody

As a writer and communicator, I revel in the challenge of boiling ideas down to one single point that clearly defines an issue at hand. I’ve been accused, in my personal life, of over-simplifying conversations that take over an hour to discuss, which I then summarize in a single statement. “So, what you’re really saying is….” Needless to say, I’m not always a favorite person during those times.

But, in the healthcare industry, there’s so much that is unclear and confusing that it’s very difficult to pinpoint exactly what should be said or how to say it. And, not in my wildest dreams would I want to be the Secretary of Health and Human Services when it comes to one of the most daunting tasks healthcare reform is posing — the defining of “essential” benefits in the impending 2014 state-run healthcare exchanges.

At its most basic level, the law mandates that the scope of the essential package be equivalent to that of a typical employer plan and must include 10 broad categories of services including: Ambulatory patient services; Emergency services; Hospitalization; Laboratory services; Maternity and newborn care; Mental health and substance use disorder services, including behavioral health treatment; Pediatric services, including oral and vision care; Prescription drugs; Preventive and wellness services and chronic disease management; and Rehabilitative and habilitative services and devices.

So, what’s a “typical” employer plan and what are “essential” services? How specific should the package be?

In an article posted by American Medical News online, groups like the American Academy of Pediatrics, American Society of Plastic Surgery, U.S. Chamber of Commerce, AMA Council on Medical Service, American Congress of Obstetricians and Gynecologists and the National Coalition for Cancer Survivorship are all weighing in. They each have their own ideas as to what should be included and I think it’s safe to say that more than one of those groups is going to be disappointed in the final determinations.

I don’t know what should be included. I have my own experiences with medical plan coverage at various employers but I certainly don’t feel like I could say those benefits were “typical.” I’ll be very interested to see how it all works out.