Dept of Labor Releases Report on Essential Benefits Package

The Department of Labor has released its report to HHS detailing insurance coverage in typical large group employer health plans.  The report will be used by HHS, along with a recommendation by the Institute of Medicine, to determine what benefits/services will be included in the “Essential Health Benefits Package”, which will make up the minimum insurance plan that can be sold as part of the “Health Exchanges” scheduled to roll out in 2014.

The DOL report scrutinized 12 medical benefits not included in previous reports, specifically, “prosthetics”.  The report states that just 46% of large group employer health plans include prosthetics in their “plan documents”. This would seem to counter an AOPA commissioned study that identified nearly 75% of group plans included some type of orthotics/prosthetics coverage.  However, when asked specifically about “prosthetics” nearly all plans included some sort of coverage (often with annual caps), but just did not mention it in their plan documents.  For more information, please see the full Dept. of Labor report, prosthetics are covered on pages 23-24.

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