State Employee Healthcare Plan Chosen as Maryland’s Benchmark

Governing Magazine recently reported that Maryland was one of two states to select its own state employee healthcare plans as the best in the state.  The selection was made in response to a U.S. Department of Health & Human Services request for each state’s benchmark for essential health benefits, which are 10 categories of care.  The Affordable Care Act ensures that health plans offered in the individual and small group markets cover the ten categories,

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management, and
  10. Pediatric services, including oral and vision care

In Maryland, the Maryland Health Care Reform Coordinating Council, co-chaired by Lt. Gov. Anthony Brown, was tasked with selecting the state’s benchmark.  As reported in Governing, stakeholders described the employee plan as matching private plans in some categories, while surpassing them in others.

While generally matching private and federal plans in some of the most-used categories like prescription drugs, the state employee plan proved more comprehensive and generous in others. For example, the state plan covers skilled nursing for 180 days a year-far greater than the federal employee plans. It also included in vitro fertilization and smoking cessation drugs, coverage left out of the small employee and HMO policies.

The U.S. Department of Health & Human Services provides more information on the Affordable Health Care Act and Maryland.

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