Wednesday, September 12, 2012

State council considers required insurance benefits

By Jamey Dunn 

Illinois officials are weighing choices that could determine the future of the insurance market in the state for the near future.

As part of the Affordable Care and Patient Protection Act, Gov. Pat Quinn’s Health Care Reform Implementation Council is working to determine a benchmark for benefits that insurance companies must offer to individuals and small businesses in Illinois. “The benchmark will have an impact on insurance that’s sold both on and off the [online insurance] exchange,” Coleen Burns, special council for health policy for the Illinois Department of Insurance, said at a meeting of the council today.

The council will recommend one plan that will set the standard for benefits offered in 10 service categories, such as prescription drugs, maternity care and laboratory services. These basic required offerings are known as essential health benefits.

The council can choose between several existing plans, such as the three largest state employee health plans or the three largest group plans in the state. Once the council picks one plan to use as a model, other insurers must offer benefits under the 10 categories that are equal to the value of benefits offered in the plan. Illinois must pick a plan as is and cannot add on or subtract benefits. The standards set by the council will kick in in 2014 and last until 2016, when the federal government plans to reassess the required essential benefits.

 Burns said the choice will set a floor for required benefits, but insurance companies can offer more generous plans. “A[n insurance] carrier is at liberty to sell a bronze plan, a silver plan and a platinum plan, but all three plans must meet the benchmark.”

The council is taking public comment and suggestions through September 19, and Quinn must make a recommendation to the federal government by September 30. If the state does not choose a benchmark plan, the feds will choose one for it.

Council members have to weigh several areas of interest when considering what essential benefit requirement to recommend. Members of the committee said they hope to ensure that there are strong benefit levels for mental health and substance abuse treatment, which are two areas they say are often inadequately covered by insurance. “It truly signals that there is greater acceptance and understanding that the treatment of mental health disorders and substance abuse must be a priority,” said Lorrie Rickman Jones, director of the Department of Human Services' Division of Mental Health.

Russell Welcherd from Quincy asked that the council pay close attention to the benefits related to treating chronic disease. Welcherd has a genetic disorder that causes emphysema. He receives weekly treatments for his illness. “If a health insurance policy that discourages the proper treatment is imposed, people like me will ultimately suffer.” Welcherd said that without his treatment he would have to make frequent emergency room visits and be placed on oxygen therapy.

Larry Barry, president of the Illinois life Insurance Council, warned Quinn's council members that requiring plans to have overly generous benefits could make the insurance too pricey for many individuals and small businesses. “Now you’ve got a wonderful product, but it’s one that no one can afford.” He also asked state officials to make their decisions in a timely manner and let insurers know what is expected of them, so they can change their offerings accordingly. “We, as the sellers of this product, aren’t going to be able to wait until the last minute.”

For more on the state’s implementation of the Affordable Care Act, see the current Illinois Issues.

To submit a comment to the implementation council, go to


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