The Essential Plan

All plans must have essential items under the mandate, but coverage levels can be determined by the employer—Bronze level 60%, Silver level 70%, Gold level 80% and Platinum levels 80%. Each level corresponds with how much of the plan cost will be covers by the employer.

Right now minimum benefits required include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse treatment, including behavioral health treatment; prescription drugs; laboratory services; wellness and preventative services; chronic disease management and pediatric services, including oral and vision care.

To ensure larger business owners provide the minimum coverage, the government will provide an online benefit calculator that can determine if your health-care plan meets the requirements set by the mandate. Insurance carriers will ensure compliance for smaller insured plans, and all products on the exchange must offer the basic benefits, so many NARI members will not need to consider the calculator.

The mandate is still under development in some regards and certain details, including costs, providers and premiums, are unknown until the mandate starts. Keep in mind that finding the right solution for your company will require an evaluation of current health coverage plans and calculation of rates under the essential coverages that are required by the government. Although we do not know the essential plan coverage levels in any detail, they be will similar to the plans for each state as noted in this federal government publication, http://cciio.cms.gov/resources/files/largest-smgroup-products-7-2-2012.pdf.PDF.

Over time, as the mandate continues to change and evolve, so will your health-care plans. As the cost analysis of providing a plan and business acumen come into play, your solution will become clear whether you can provide health care and, if so, what needs to happen in order to continue doing this. For example, you may find that budgeting for health care makes good business sense because it attracts top-notch talent away from competitors.

Read Voluntarily providing health coverage: 4 scenarios for more information about how healthcare can be provided to your employees under the new mandate.

One thought on “The Essential Plan

  1. Pingback: Overview of NARI National Webinar, Healthcare Mandate: What’s Next? « NARI National News

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