With the inexpensive Care Act mandating that most people having health insurance, but those who are young and healthy– are questioning why it is necessary. You will never need it but still health insurance is a service you pay for it.
Insurance companies are experts at negotiating with hospitals so if you are in system, or outside of their system, the hospital has a reason to come to a contract with your insurance company on prices.
With health insurance, in many cases your doctor can covenant minor health problems before they become major ones. You can go to a primary care physician (or PCP) or even a expert in place of the ER.
In addition to the standard 10 EHB categories detailed below, states may include additional benefit needs under their own state system or within a state’s selected standard plan.
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services (including behavioural health treatment)
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Paediatric services, including oral and vision care
Any health plan that covers EHBs must include these benefits with no annual limits or lifetime maximums. This includes self-insured and large group plans (having 51 or more employees). Effective January 1, 2017, plans that offer out-of-system benefits on EHBs may no longer place limits or maximums on those benefits.
The state standard plan is determined differently based on the plan’s funding type:
Employers that self-insure their plans can select a state to use for their standard plan.
Employers with insured plans must use the standard plan of employer’s contract state, except for HMO plans which must follow the HMO plan state.