Many states are still working out their plans for the Affordable Care Act.  While the “individual mandate” and the “guaranteed coverage” aspects of the Affordable Care Act have received wide attention, few people know about a provision of the law that has a much wider impact – the “essential health benefits” provision which is aimed to protect people from being underinsured.

Tennessee will hold six public hearings on the Affordable Care Act provision of essential health benefits.  The hearings are to gather information as the state defines the essential health benefits for insurance plans in Tennessee. The section applies to individual policies and small-employer group plans after Jan. 1, 2014.

The federal government has stipulated 10 basic coverage points, ranging from dental care for children to hospitalizations, which these insurance plans must provide. It has given states the task of grouping plans according to a system that makes it easy for people and small-business owners to choose a policy.

The Affordable Care Act states that these plans must offer the same level of coverage as those typically offered by a large employer. Besides child dental care and hospitalizations, the plans must also cover outpatient services, emergency visits, maternity and newborn care, mental health, laboratory tests and wellness services, including chronic disease management.

The hearings will gather recommendations from the public on which of the 10 potential benchmark plans designated by the U.S. Department of Health and Human Services should be chosen by the state.  Modifications will be discussed and comments will be accepted.

The first of the hearings were at Vanderbilt University in Nashville. There were other public hearings in Kingsport and Knoxville on July 31, Cleveland on Aug. 1 and Memphis and Jackson on Aug. 3.  The meetings will be conducted by state Commerce and Insurance Commissioner Julie Mix McPeak.

Advertisements