4 ms·
Insurance companies are not legally required to provide the same coverage, rates, deductibles, and benefits as every other insurance company.
by russdill 3y ago
Insurance companies are not legally required to provide the same coverage, rates, deductibles, and benefits as every other insurance company.
- lotsofpulp 3y agoYes, they are required to provide (broadly) the same "coverage" and "benefits". The things that change are network of providers, deductibles, and oop max. If you have diabetes, no matter which plan you choose from UHC/Elevance/CVS/Cigna/Humana/Centene/Molina/etc, you should be covered for all the same evidenced based care from all insurers. You should also be covered the same for a host of preventative services as required by law: https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...
- russdill 3y agoIf you have a high deductible plan and don't meet your deductible, are you really getting coverage? If you had diabetes, which plan would you choose, one that covers insulin supplies 100% or one that only covers the bare minimum, and even only then if you reach your deductible. Oh, and all the good specialists for diabetics just happen to be out of network.
- lotsofpulp 3y agoI am not sure what any of this has to do with employers choosing employee's insurance. >If you have a high deductible plan and don't meet your deductible, are you really getting coverage? Yes, because you purchased insurance for when costs exceed $x. >If you had diabetes, which plan would you choose, one that covers insulin supplies 100% or one that only covers the bare minimum, and even only then if you reach your deductible. If there is evidence to support to use of insulin supplies, then all insurance plans should cover them the same, obviously subject to the plan's deductibles/oop max. >Oh, and all the good specialists for diabetics just happen to be out of network. Yes, this is the one variable for insurance plans. Presumably, insurance plans with higher premiums pay providers more, and hence a more expensive insurance plan will have more in network providers.
- russdill 3y agohttps://www.macipa.com/wp-content/uploads/Diabetes_Tierchart_April2020_Final.pdf https://www.macipa.com/wp-content/uploads/Diabetes_Tierchart...
- lotsofpulp 3y agoI stand corrected! Apparently ACA does not require coverage for all evidenced based medication, but rather coverage for at least 1 medicine in the class of medication? https://www.verywellhealth.com/what-is-covered-under-obamacare-4083032 https://www.verywellhealth.com/what-is-covered-under-obamaca... > Individual and small group plans must cover prescription drugs, and their formularies (covered drug lists) must include at least one drug in every United States Pharmacopeia (USP) category and class—or more, if the state's benchmark plan includes more.16