SilverGoldPlatinum60%70%40%30%Insurer PayPatient Pay80%90%20%10%
1/30/20176Essential Health BenefitsAmbulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health and substance use disorder services, including behavioral health treatmentPrescription drugsRehabilitative and habilitative services and devicesLaboratory servicesPreventive and wellness services and chronic disease managementPediatric services, including oral and vision careOther Exchange PlansCatastrophic Coverage◦Target Audience◦those under age 30◦or whose premium > 8% of income◦Less coverage, but lower premiumBasic Health Plan◦Target Audience◦those under 65 with income 133%−200%◦Same coverage, but lower premium instead of subsidizing individual’s premium for regular coverageMedicaid and CHIP◦Eligibility assessmentState-Run Exchange BasicsMay be a governmental agency or State-established nonprofit entityMay be multiple subsidiaries within one State (with no overlap in geographic area served), regional (i.e., multi-state), or single state◦Must have at least two multi-state plans in each Exchange◦at least one of which must be offered by a nonprofit
1/30/20177Preventive Care: ContraceptionFood and Drug Administration (FDA)-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs)◦Does not apply to health plans sponsored by certain exempt “religious employers.”Burwell v. Hobby Lobby Stores, Inc.Issue: Whether the Religious Freedom Restoration Act allows a for-profit corporation to deny its employees the health coverage of contraceptives to which the employees are otherwise entitled by federal law, based on the religious objections of the corporation’s owners.Hobby Lobby’s ArgumentHobby Lobby’s owners contend that PPACA's requirement that health insurance plans cover contraception will force them to either: ◦violate their religious beliefs or ◦suffer financial penalties for violating the lawThey don't object to covering all contraception◦only the emergency contraceptive pills Plan B and Ella, and all types of intrauterine devices (IUDs)◦they (erroneously) believe these are abortifacientsThe company admits in its complaint that until it considered filing the suit in 2012, its health insurance plan covered Plan B and Ella.◦The company also invests in the makers of both drugs.
1/30/20178Hobby LobbyControversyThe company is asking the court to find that it has the same religious-freedom rights as a church or an individual, a finding no American court has ever made.◦Arguably most well-publicized and controversial element of the case◦
You've reached the end of your free preview.
Want to read all 99 pages?
- Spring '08