State Health Benefit Mandates Come with New Costs

Margaret Dick Tocknell, for HealthLeaders Media , March 14, 2012

Still, there's some reason for concern because nongroup (individual) plans aren't a benchmark option for essential benefits. According to the report, in some states, benefit mandates for individual plans often exceed mandates for small-group plans. In this age of tight budgets states may want to take a hard look at those individual plan mandates to avoid needing to offset those costs.

Chapin White, PhD, a senior health researcher at the Center for Studying Health System Change, and one of the NIH report's authors, cautions that states need to look beyond merely avoiding a mandate liability in selecting its benchmark plan.

"If all a state wants to do is avoid that liability," he says, "then it shouldn't select a small group plan as its benchmark." He adds that the benchmark decision needs to be based on much more, including why the mandate was put in place.

According to the study, some state mandates aren't always covered by other benchmark plans. In vitro fertilization services and applied behavioral analysis therapy for autism, for example, are covered by some small-group plans but are not typically included in the other benchmark plan options.

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