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Top 10 Health Plan Stories of 2011

Margaret Dick Tocknell, for HealthLeaders Media, December 19, 2011

It has been a year full of health plan surprises as insurers prepare for the continued implementation of healthcare reform. Controlling the patient cost curve was the focus of mergers, acquisitions, and new alliances undertaken during 2011.

New rules set minimum standards for medical costs, and one insurer took a controversial step it hopes will help control healthcare costs. And as an early Christmas gift for health insurers, the Department of Health and Human Services declined to set a federal standard for essential benefits.

Here, in no particular order are the top health plan stories of 2012:

1.HHS Punts on Essential Health Benefits
Charged with the political hot potato of deciding just what benefits health plans will be required to cover as part of the Patient Protection and Affordable Care Act, HHS took a time honored approach—it kicked the decision down the road.

On a Friday afternoon in mid-December when most people were probably thinking more about Christmas shopping than healthcare policy, HHS announced that each state will have the flexibility to select an existing health plan to set the benchmark for the items and services included in an essential health benefits package.

States will still have to make sure that their health insurance plans cover the 10 categories of care mandated in the PPACA, such as preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs, but this decision provides states with flexibility in how the categories will be covered.

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