Oregon’s Insurance Exchange to Determine Essential Benefit Package

Before such decisions are made, Rocky King, executive director of the exchange, wants to consult with the Insurance Division, insurance companies and stakeholder groups
The Lund Report

December 22, 2011—The U.S. Department of Health and Human Services is keeping its hands off what needs to be included in the essential benefit package for state insurance exchanges.

“That, to us, is great news,” said Rep. Mitch Greenlick (D-Portland) during a joint meeting of the House and Senate healthcare committees on Tuesday. “That gives the state of Oregon the ability to give what its citizens want and need.”

Last Friday, the federal department released a bulletin stating that it would not create a prescriptive and detailed list of services that must be included in the package, as states had previously expected. Instead, the department has created four “benchmark plans” that are broad in scope and allow states to create an essential health benefits package within the scope of the chosen benchmark plan.

An “essential health benefits package” is a list of health services and benefits that insurance plans must offer in a state health insurance exchange, and includes health benefits and services that fall within ten categories: ambulatory patient services; emergency services; hospitalization; maternity and infant care; prescription drugs; mental health and substance abuse services; laboratory services; preventive services; rehabilitation services and pediatric services.

Under the Affordable Care Act, the Department of Health and Human Services must create the list of services and benefits offered by the exchange to ensure that health plans being offered are not of lesser value than other options. Consumer groups had hoped the department would have created a detailed list of all the necessary requirements.  

In Oregon, the insurance exchange is working with the Oregon Insurance Division and the Oregon Health Authority to determine what sort of process the three agencies will undergo to create this package of benefits, said Lisa Morawski, the exchange’s spokeswoman, adding that a timeline has not been developed.

Such a benefits package will not be included in the business plan presented to the February legislative session, Rocky King, the exchange’s executive director, told Rep. Bill Kennemer (R-Oregon City) on Tuesday.  

“I don’t think we want to hurry into that kind of discussion,” King said, adding that creating an essential benefits package in four weeks “would not be prudent” because there wouldn’t be time to involve the Insurance Division, the insurance companies and other stakeholder groups.

“We’re going to have to pull a lot of folks together,” Greenlick said.

King said the exchange also needs more information from the federal government, particularly around cost sharing.

Insurance exchanges are meant to be a one-stop shopping place for uninsured individuals and small businesses to find, compare and purchase affordable health insurance. Oregon’s legislature set in motion the creation of an exchange with the passage of Senate Bill 99 earlier this year. The exchange is expected to begin enrolling people in late 2013, and provide coverage by January 2014.

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