- Report Published -
|The Essential and Standard Health Benefit Plan|
|Special Advisory Commission on Mandated Health Insurance Benefits|
|Section 38.2-3431 of Title 38.2 of the Code of Virginia requires that the State Corporation Commission (SCC) modify the regulations establishing the essential and standard plans to incorporate any revisions to the plans submitted by the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission). The regulation governing the essential and standard plans is based primarily on the work of the Essential Health Service Panel (Panel). The Panel was composed of a group of health care professionals and citizens appointed by the Governor and the Chairman of the Commission on Health Care for All Virginians. |
House Bill 2234 was introduced in the 2003 Session of the General Assembly by Delegate Albert C. Pollard. The bill was passed and became effective on July 1, 2003. The bill revises the provisions in the small employer group provisions and the essential and standards plans. The bill specifically includes the ability of carriers to include cost-sharing features in the plan including co-payment, co-insurance, deductible or other cost-sharing arrangements. The bill exempts the plans from the mandated provider requirements of § 38.2-3408.
The essential and standard plans were discussed at the July 9, 2003 meeting of the Advisory Commission and a public hearing on the plans was held on September 15, 2003. Information on the development of the plans, the experience of the plans in Virginia and other states, and previous recommendations for changes was presented. Comments were made by the Virginia Association of Health Plans (VAHP), the Health Insurance Association of America (HIAA), the Virginia Chamber of Commerce (VCC) and the National Federation of Independent Businesses (NFIB).
The second alternative offered by the Bureau of Insurance was preferred by the VAHP. The alternative requiring three different versions of the essential plan was considered a costly and unnecessary option. The Bureau of Insurance subsequently suggested the use of the second alternative combined with the ability of the carriers to offer the plan with different levels of co-payments and deductibles. This option was offered as a means of including flexibility in the plans that is similar to other products in the market.
The interested parties preferred the second alternative combining reductions in dental, vision, and prescription drug coverage with flexibility in deductibles and co-payments. However, all parties agreed that the changes would not guarantee that in the future the plans would be the choice of more small employers. It was also acknowledged that the suggested changes would require administrative changes and costs to insurers.
On November 17, 2003, the Advisory Commission voted unanimously (9-0) to recommend that no changes be made to the essential and standard health benefit plans. The Advisory Commission members expressed concern that a legislatively created product was difficult to modify to compete in the rapidly changing health insurance market. Advisory Commission members were also concerned that the recommended changes would not result in increased sales of the plans.