Saturday, August 8, 2009

HR 3200, Section 121

(a) In General- A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved.
(b) Choice of Coverage-
(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
(2) EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS- In the case of an Exchange-participating health benefits plan, such plan is required under section 203 to provide specified levels of benefits and, in the case of a plan offering a premium-plus level of benefits, provide additional benefits.
(3) CONTINUATION OF OFFERING OF SEPARATE EXCEPTED BENEFITS COVERAGE- Nothing in this division shall be construed as affecting the offering of health benefits in the form of excepted benefits (described in section 102(b)(1)(B)(ii)) if such benefits are offered under a separate policy, contract, or certificate of insurance.
(c) No Restrictions on Coverage Unrelated to Clinical Appropriateness- A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.”
1. Private insurance has to meet government-approved standards for the benefits they offer.
2. You will be permitted by your government to buy additional insurance to supplement the lousy insurance they offer – just like Medicare enrollees have to buy additional “Medigap” insurance to cover some of their expenses.
3. Insurance companies that want to be part of the new government “insurance exchange” and actually try and live under their thumb as I’ve described above have to meet certain requirements, as will be outlined in part in the next section.
4. Once again, you will be permitted to buy coverage for “extras” like vision, dental, etc. Permitted. Ugh.
5. A QHBP, “qualified health benefits plan” (one of the insurance companies that’s playing ball with the government) will not be permitted to restrict benefits except when that restriction is deemed to be “clinically-appropriate”.
This one almost slipped right by me. Who gets to determine what is and what is not “clinically-appropriate”? Well, Der Kommissar, of course! He/she will make this determination after consulting with a health board, which is described in later sections. This board will only have a few doctors on it. The vast majority of its members? Government appointees from the ranks of “labor” (unions), federal employees, etc. That’s right. A bunch of bureaucrats and political spoils will be deciding what is and is not “clinically appropriate” for us. Evidence-based medicine will be drowned out by the voices speaking for the government bureaucracy. Sick.

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