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Give the Lady the Gift That Keeps on Giving: Health Insurance Exchange Information

Women’s health has been at the forefront of health care reform. This is no surprise to anyone; women use more health services than men as a result of reproductive care, higher probability of chronic diseases and generally longer life expectancies. Women are most often responsible for selection and administration of her family’s healthcare, regardless for whom health care is the benefit. Also women now represent more than 30% of new small business owners, and as a result are assuming responsibility for employer sponsored health insurance.

>A key component of the healthcare plan are health insurance exchanges (HIX). Given that women are closely involved in the selection of their own health insurance, in addition to their employees’ health benefits, it’s critical that they become well-informed as to how the health care of women is met by the HIX.

>Essential Health Benefits, services that the HIX is required to offer in their plans, has perhaps the most significant impact on women. These essential health categories include reproductive care, mental health, and chronic illness management, among others. As a result, the details of coverage of these benefits in plans that are offered through the HIX will be very important. States are expected to choose a benchmark minimum that plans are required to meet to be sold on the HIX. Depending upon whether the HIX is state run only, jointly federal and state run, or federal only, the benchmark plan may be different.

>Preventative Services will be offered without cost sharing to all beneficiaries. Women, however, may find that over time they use more costly services. Pap Smears. mammograms, newly recommended vaccines and, in some cases contraceptives, are a partial list today. In order to take advantage of preventative services with cost sharing, women will be required to use a provider within their network. Additional rules will also apply so that some particular types of services or formularies may not be available.

>Women are at a substantially higher risk for chronic diseases than are men, most often those that necessitate ongoing treatment like heart disease, hypertension and diabetes. Other high risk chronic diseases include eating disorders, depression and anxiety. As chronic diseases require ongoing care, it will be imperative that women are certain that their plan effectively cover treatment. By treating these diseases early, future expenses can likely be limited.

>Health and Human Services (HHS) has indicated that the exchanges will be ready for enrollment on October 1. They differ state by state, so to the extent that your state has information, it’s never too early to take a look.

For additional information, contact EAB HealthWorks.