What will you get with hb 3200?

Hope you read my first post. This is part 2 of a discussion of h b 3200.

You will have access to a public or private plan. I'll describe the public plan. Keep in mind that all private plans must be equal to or better than the public plan.

The plan will have three levels: basic, enhanced, and premium. And there can be a "premium plus." The basic plan must include:

Guaranteed issue; guaranteed renewal; rescissions prohibited;
Hospitalization;
Hospital, clinic and emergency room out-patient services;
Health professional services;
Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate;
Prescriptions;
Rehabilitive and habilitive services;
Mental health/substance abuse disorder services;
Preventive services;
Maternity services;
Well baby and well child services.

The preventive services must be at not cost to you.
Your out-of-pocket expenses will be limited to $5,000 (single)/$10,000 (family).
There will be no annual or lifetime limit.
Benefits must be provided that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits in the package.

BUT WAIT - THERE'S MORE!!

You can choose the Enhanced package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 85 percent of the full actuarial value of the benefits in the package. This just means you will pay less out-of-pocket.

AND THERE'S MORE!!

You can choose the Premium package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 95 percent of the full actuarial value of the benefits in the package.

OH, AND ONE MORE THING:

You can choose the Premium Plus package. In that, you get adult oral health and vision care. Children already get that under the Well Child coverage above.

That's a great list, so you know that private ins. co. will be jumping into that. There are big profits available!!

So...can you keep your current plan? Of course you can. If you have an individual plan, your ins. co. must model its benefits to the basic plan detailed above. You know it will jump on that advantage.

So...can you keep your doctor? Of course you can. Your ins. co. must provide "adequate networking." That means it must offer lots of choices of drs. and other services. Then there is this that really concerns me (it's on page 58):

One of the goals for financial and administrative standards specified in paragraph D on page 58 states that such standards shall

enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card...

What a deal!!! How can anyone pass this up?