May 13, 2011

DOL Study on Selected Medical Benefits

The Department of Labor (DOL) recently submitted a report to the Department of Health and Human Services (HHS) on “selected medical benefits.”  The Affordable Care Act (ACA) had required the DOL to conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, and to report the results of the survey to the HHS.

The survey found that of those employees covered by an employer health benefits plan, 79 percent received benefits under a fee-for-service arrangement in 2009, where payment wasn’t made until services were received. Most of those in fee-for-service plans were in the sub-category of plans known as preferred provider organizations (PPOs), where enrollees are provided medical services at a higher level of reimbursement if they receive care from designated providers. The remaining 21 percent were covered by a health maintenance organization (HMO), generally characterized by a fixed set of benefits provided for a prepaid fee, often with restrictions on available providers.

The results of the DOL survey are intended to help define what makes up essential health benefit plans. According to the Act, HHS must ensure that the scope of essential health benefits is equal to the scope of benefits provided under a typical employer plan.