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Examples of Benefit Package
Statutory Guidance
This appendix includes a display of benefit categories in statute for various health insurance programs.
Federal Employees Health Benefits Program (FEHBP) | Medicare | Medicaid | Knox-Keene Health Care Service Plan Act (CA) | Maryland | Massachusetts Exchange | |
Year Created | 1959 | 1965 | 1965 | 1975 | 1993 | 2006 |
Categorization of Benefits | Service Benefit Plan | Part A | Mandatory Services | Basic Health Care Services | Comprehensive Standard Health Benefit Plan (CSHBP) | Minimum Creditable Coverage Standards |
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Indemnity Benefit Plan | Part B | |||||
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Part C (Medicare Advantageb) | ||||||
Is required to provide all Medicare-covered benefits to enrollees, with at least one plan with basic drug coverage (MA-PD plan) | ||||||
Part D • Prescription Drugs |
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Optional Services |
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Statutory Authority | U.S. Code: Title 5-Government Organization & Employees Part III-Employees Subpart G-Insurance & Annuities-Chapter 89-Health Insurance-Section 8904 | Title XVIII of the Social Security Act | Title XIX of the Social Security Act |
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Chapter 58-956 CMR 5.00 |
a Flu shot, pneumococcal shot (no coinsurance); limit of one flu shot per flu season; hepatitis B shot, colorectal and prostate cancer screening, pap smear, mammogram, cardiovascular screening, abdominal aortic aneurysm (AAA) screening, bone mass measurement, diabetes screening and monitoring, glaucoma screening, smoking cessation.
b Private health plans that receive payments from Medicare to provide Medicare-covered benefits to enrollees.
SOURCE: Families USA, 2006; GPO, 2007; KFF, 2010; O’Malley et al., 2009; State of California, 2011; State of Massachusetts, 2008.
REFERENCES
Families USA. 2006. Medicaid benefit package changes: Coming to a state near you? http://www.familiesusa.org/assets/pdfs/DRA-Benefit-Package.pdf (accessed August 4, 2011).
GPO (Government Printing Office). 2007. Title 5 government organization and employees. Part III—employees. Subpart g—insurance and annuities. Chapter 89—health insurance. http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=browse_usc&docid=Cite+5USC8904 (accessed August 4, 2011).
KFF (Kaiser Family Foundation). 2010. Medicare: A primer. Menlo Park, CA: Kaiser Family Foundation.
O’Malley, M., M. Moon, and R. W. Cowdry. 2009. Maryland’s Comprehensive Standard Health Plan for Small Businesses. Annapolis, MD:Maryland Health Care Commission.
State of California. 2011. Knox-Keene Health Care Service Plan Act of 1975. http://wpso.dmhc.ca.gov/regulations/11kkap/index.htm (accessed August 4, 2011).
State of Massachusetts. 2008. 956 CMR 5.00: Minimum creditable coverage. http://www.lawlib.state.ma.us/source/mass/cmr/cmrtext/956CMR5.pdf (accessed August 4, 2011).