CHICAGO – Illinois officials chose a relatively lean small-group policy Friday as the benchmark plan for essential health benefits in the state, another milepost in implementing President Barack Obama’s health care law.
Gov. Pat Quinn’s health care council approved Blue Cross Blue Shield’s Blue Advantage plan as the benchmark at a meeting in Chicago. It will be submitted to the U.S. Department of Health and Human Services, which will take public comment.
Ultimately, the benchmark plan will determine the cost of future premiums and how broad coverage will be for many Illinois patients.
To be sure, other health policies will be sold in Illinois when much of the health care law takes effect in 2014. But the benchmark acts as a minimum standard for the type of medical services that must be covered in plans sold to individuals and small businesses under the law.
“For most people, it does not matter. The truth is the health issues that most people have or will have are covered by most any plan that might have been a benchmark plan,” said attorney Ian Spatz of Manatt, Phelps and Phillips, a law firm consulting with states and health care providers on what critics have called “Obamacare.”
But, Spatz added: “What Illinois doing is important. It’s informing the insurers in
Illinois what they have to begin to design to be offered in 2014.”
The Illinois governor’s council also approved benchmarks for children’s vision and dental care, which must be covered under the federal law, but aren’t currently covered by most Illinois policies.
The council chose a federal plan as a model for children’s vision care and the state’s own All Kids coverage as the standard for children’s dental care.
Obama’s health law set 10 basic categories that must be covered by health plans, such as emergency services, prescription drugs and maternity care.
Children’s vision and dental care are on that list. Within those categories, states determine a basic level of covered services and costs.
The Blue Advantage plan is one of the leaner small-group health policies sold in the state, said Colleen Burns of the Illinois Department of Insurance. It puts a $1,000 annual limit on care from chiropractors. It covers only “medically necessary” weight-loss surgery. It doesn’t cover routine vision or hearing exams for adults.
It covers all the services that Illinois law mandates, such as treatment for autism and infertility.
But it doesn’t cover massage or acupuncture, for example, which disappointed Chicago acupuncturist Tom Hurrle.
“We’re glad that this will be reviewed during the next two years,” Hurrle said. There will be more recognition of acupuncture as more research supports its cost-effectiveness, Hurrle said.
It wasn’t the leanest plan evaluated by the state.
That was United Healthcare’s Choice Plus plan, which sets limits on substance abuse treatment, mental health services and physical therapy.
The governor’s office asked a group of doctors to review the health policies under consideration, focusing on their service limits and exclusions, Burns said.
The doctors “noted that if United Healthcare’s Choice Plus plan became the benchmark, coverage could prove insufficient in the event of serious medical events such as a stroke,” Burns said.
“Under the Affordable Care Act, health insurance policies will afford every American access to care under these 10 covered essential services,” said Michael Gelder, Quinn’s chief health care adviser.
Gelder said that contrasts “with what happens today in an insurance market where policies can be sold with a much more limited set of services that are covered.”
