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User Name Thread Name Subject Posted
heric BS: US Health Care Reform (1349* d) RE: BS: US Health Care Reform 31 Aug 09


(Yes thanks Art - I should drop that little flourish.)

Carol: Section 111(b)(1)(A):

Each HAPI plan offered through an HHA shall--

(A) provide benefits for health care items and services that are actuarially equivalent or greater in value than the benefits offered as of January 1, 2009, under the Blue Cross/Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program under chapter 89 of title 5, United States Code, including coverage of an initial primary care assessment and annual physical examinations;

(B) provide benefits for wellness programs and incentives to promote the use of such programs;

(C) provide coverage for catastrophic medical events that result in out-of-pocket costs for an individual or family if lifetime limits are exhausted;

(D) designate a health care provider, such as a primary care physician, nurse practitioner, or other qualified health provider, to monitor the health and health care of a covered individuals (such provider shall be known as the `health home' of the covered individual);

(E) ensure that, as part of the first visit with a primary care physician or the health home of a covered individual, such provider and individual determine a care plan to maximize the health of the individual through wellness and activities prevention;

(F) provide benefits for comprehensive disease prevention, early detection, disease management, and chronic condition management that meets minimum standards developed by the Secretary;

(G) provide for the application of personal responsibility contribution requirements with respect to covered benefits in a manner that may be similar to the cost sharing requirements applied as of January 1, 2009, under the Blue Cross/Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program under chapter 89 of title 5, United States Code, except that no contributions shall be required for--

(i) preventive items or services; and

(ii) early detection, disease management, or chronic pain treatment items or services; and

(H) comply with the requirements of section 112.


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