MONTPELIER — One of the first steps in creating a smorgasbord that allows customers to compare health insurance plans was unveiled Thursday, as officials proposed templates and a requirement for private health insurance companies.
At a news conference and Green Mountain Care Board meeting, state officials identified a “benchmark” health insurance plan and children’s dental plan for use as templates that other insurers will roughly follow.
They also recommended that the state require health insurance companies to provide benefit packages for both rehabilitative care and habilitative services for those with disabilities, rather than allowing insurers to define coverage in those areas.
“This is the first step in allowing apples-to-apples (comparisons),” Mark Larson, commissioner of the Department of Vermont Health Access, said Thursday at a Green Mountain Care Board meeting.
The recommendation called for Blue Cross Blue Shield of Vermont to be used as the “benchmark” health insurance plan for single and small-group plans in the state’s health benefits exchange.
The health benefits exchange, part of federal health care reform, will allow Vermonters to compare health companies’ plans. The exchange is separate from Vermont’s single-payer health care system currently being developed. The state expects people could begin “shopping” on the exchange as of Oct. 1, 2013.
Employers with more than 50 employees will continue to run outside the exchange until a later time.
Thursday’s recommended template allows companies to see what basic requirements are needed, but there is some flexibility.
“The package of covered services for any carrier that wants to offer a plan would have to work with this basic package,” Larson said. “We are not ... picking a company over other companies.”
The other recommended template, which covers children’s dental care, proposed using the state’s Children’s Health Insurance Program, also known as Dr. Dynasaur, an option for uninsured children under 18.
State officials also proposed having insurance companies make the same services available for both habilitative care and rehabilitative services. Rehabilitative services are for injury recovery, while habilitative services are for long-term conditions such as disabilities.
An alternative to that option, which state officials did not recommend, would mean companies could define how habilitative care is covered, then submit those definitions to the federal government for review and approval.
The Affordable Care Act, also referred to as Obamacare, defines 10 categories that plans both in and out of health care exchanges must cover. They range from emergency services to prescription drugs and mental health services to rehabilitative care.
About 77 percent of those expected to use a benefits package in Vermont’s exchange will use Blue Cross Blue Shield, so state Health Care Reform director Robin Lunge said there will be a familiarity.
Although prices may vary between insurance companies, an analysis showed that they provide essentially the same product. Lunge said most people may think the state health plan has significantly better coverage than private plans, but there was a difference of less than 1 percent between the state health plan and MVP Health Care.
Officials expect to discuss whether the exchange should have restrictions or discretion for insurers in the cost of co-pays, co-insurance and deductibles during a Green Mountain Care Board meeting on Aug. 21.
A public comment period for the recommendations covering the two templates and habilitative care will last until the end of the month. Those wanting to comment can call the Green Mountain Care Board at 828-2130, email Sam Lacy at firstname.lastname@example.org, or post comments through a form on the gmcboard.vermont.gov website.
The board plans to vote on the recommendations Sept. 20.MORE IN Vermont News
- Most Popular
- Most Emailed
- MEDIA GALLERY