The Affordable Health Care for America Act (H.R. 3962), which the House approved by a narrow margin on Nov. 7, eventually would require employer-sponsored health insurance plans to provide, at a minimum, a certain essential benefits package.

[However,] because the essential benefits package would be based on the benefits typically covered by employer-sponsored health insurance, it appears that most employers need not worry about major adverse effects of this particular health reform bill.

A new Health Benefits Advisory Committee (HBAC), including employer members, would determine the benefits to be covered in the essential benefits package. . . . To that end, the Department of Labor would conduct a survey of employer-sponsored coverage to determine the benefits typically covered and report results to the HBAC and to the Department of Health and Human Services.

The minimum services to be covered are those typically covered by employer-sponsored plans: hospitalization, outpatient hospital services, medical services and related supplies, prescription drugs, behavioral health, etc.. Recommended preventive services, including immunizations and well-baby and well-child care must be covered at no cost to the insured. Currently, most employer-sponsored plans require some cost-sharing for preventive care services.

The cost-sharing under the essential benefits package must be designed to provide a level of benefits that is actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package with no cost-sharing.

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