SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS


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Whether is it called the Patient’s Protection and Affordable Care Act, PPACA, Affordable Care Act or Obamacare, everyone knows what law is being referred to but after a year, people are still unclear of what is in it.

Last year, after the most controversial legislation of the last 50 years became law I started explaining one section a week in the newsletter for The Insurance Barn.  In March and April my intention is to share those explanations for people who were not on the mailing list.

Each day I will share the text of a different section of the new law and my conclusion as to its meaning.  As you read them, please note that I am an insurance agent and not a lawyer.  I understand that the rules made by the Secretary of Health and Human Services may make my conclusions inaccurate.  Also, note that I understand that good people can read the same thing and come to different conclusions.

The quoted legal language is taken directly from the PPACA.  The opinion statements are my conclusions.  They may or may not be consistent with what the legal minds of the U.S. Supreme Court eventually conclude.  They are for educational purposes only so that people are able to better understand the law and plan accordingly.

SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS  
(1) IN GENERAL.—Subject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:(A) Ambulatory patient services.(B) Emergency services.

(C) Hospitalization.

(D) Maternity and newborn care.

(E) Mental health and substance use disorder services, including behavioral health treatment.

(F) Prescription drugs.

(G) Rehabilitative and habilitative services and devices.

(H) Laboratory services.

(I) Preventive and wellness services and chronic disease management.

(J) Pediatric services, including oral and vision care.

These are the categories of insurance protection the PPACA mandates that every American purchase in 2014.  This is a list of the minimum requirements that Congress mandates.  The Secretary of Health and Human Services is allowed to add coverages but not subtract from it.  Insurance Companies are allowed to offer plans with even more generous benefits but no less than the Secretary of HHS dictates.

In December of 2011, Secretary of Health and Human Services, Kathleen Sebelius, announced that the states would have the final say on what would be included in Essential Benefit plans rather than the Secretary of HHS as required by the new law.  Rather than one national plan, we will have 50 state plans.

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