As employers work to comply with some initial health care reform mandates, many are confused about a provision that could have significant impact on their future health benefit spending.
"Essential health benefits" make up part of the health care reform law's mandates to broaden affordable access to adequate health coverage. For plan years starting on or after Sept. 23, 2010, group health plans – whether insured or self-insured – cannot impose lifetime dollar limits and they must gradually eliminate annual dollar limits on essential health benefits.
Employers who have had to make changes in compliance with the dollar-limit requirements have found that it isn't always obvious whether a particular service or item is an essential health benefit. And then, of course, there's the ever-popular difference of opinion.
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