Connecticut’s health exchange board determines basic coverage

Washington — Connecticut’s health insurance exchange board has selected a mandatory benefit plan that many state residents will chose for coverage that is more generous than the federal Affordable Care Act requires.

The plan will offer abortion services, although people receiving federal help to buy health insurance will have to pay for pregnancy termination coverage out of pocket.

That plan would be the minimum health insurance companies will be able to offer when the largest phase of the Affordable Care Act is implemented in 2014.

The exchange board members decided to model the “benchmark” plan on a ConnectiCare HMO that provides coverage for thousands of state residents.

“It represents a good balance of cost and coverage,” said Kevin Counihan, the new CEO of the 14-member Connecticut health insurance care exchange.

In 2014, all states are required to have a health insurance exchange that offers individuals and small businesses a choice of plans.

Insurers participating in the exchange, or otherwise selling individual and small group coverage in Connecticut, will have to offer, at a minimum, the coverage offered in the benchmark plan.

To come up with their plan, board members decided to add a few things that ConnectiCare HMO does not provide, including prescription drug coverage and pediatric dental and vision services.

The ACA requires states to offer essential benefits in their benchmark plans, such as preventive care and mental health and substance abuse treatment as well as basic doctor and hospital care.

But Connecticut’s plan would also include other benefits, including in-vitro fertilization treatments and special autism care.

Abortion services are also part of the benchmark plan. But federal law prohibits federal money to be used for abortions, so those receiving federal subsidies to purchase health insurance will be required to pay for abortion services out-of-pocket, Counihan said.

Mickey Herbert, a member of the exchange board, said he raised concerns about the benchmark plan at a health exchange board meeting held Thursday.

“My question was ‘what’s this all going to cost’ and nobody knew,” Herbert said.

The health care board predicts about 180,000 Connecticut residents will purchase insurance through the state’s exchange within three years of operation. The board also estimates at least seven insurers will compete for customers in the exchange.

But Herbert isn’t so sure.

“Insurers may decide this is just too expensive and may not choose to participate,” he said.

Counihan said there has been “some rating analysis done,” but the health exchange board does not know yet how much the benchmark plan would cost.

He also said the ConnectiCare HMO is already a huge success in Connecticut’s private marketplace, so it the benchmark plan should be affordable to many, too.

There will be a 30-day period for the public to comment on the board’s procedures, posted on the health care exchange website, www.ct.gov/hix.

The board will then take an official vote on the plan.

 

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