A new Institute of Medicine (IOM) report provides the U.S. Department of Health and Human Services (HHS) with a set of criteria and methods to develop a package of essential health benefits that will cover many health care needs, promote medically effective services and be affordable to purchasers. Certain insurance plans, including those participating in the state-based health insurance exchanges to be established under the Patient Protection and Affordable Care Act (PPACA), must cover a package of preventive, diagnostic and therapeutic services and products in areas that have been defined as essential by HHS.
The package will establish the minimum benefits that plans must cover; insurers may offer additional benefits. The report neither recommends a list of essential benefits nor comments on whether any particular service should be included or excluded, as doing so would have been beyond the committee’s charge. The study was sponsored by HHS, and IOM offers several recommendations to HHS to consider as the department works to clarify “essential health benefits.”
The full IOM press release contains a link to download a free PDF of the report (registration is required).
