Anthem PPO plan chosen as ‘benchmark’ for state’s Health Benefit Exchange

Dept. of Insurance says the plan is most cost-effective of those reviewed

By Kentucky Health News

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange.

“Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act,” the statement issued by the Department of Insurance says. “The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014.”

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The Anthem PPO plan “is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today, according to the release. Because the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan.”

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.