[Lamplighter]

NY Times
ROBERT PEAR
November 20, 2012

Administration Defines Benefits That Must Be Offered Under the Health Law

WASHINGTON — The Obama administration took a big step on Tuesday
to carry out the new health care law by defining “essential health benefits”
that must be offered to most Americans and by allowing employers to offer
much bigger financial rewards to employees who quit smoking or adopt other healthy behaviors.<snip>

Under the rules, insurers cannot deny coverage or charge higher
premiums to people because they are sick or have been ill.
They also cannot charge women more than men, as many now do.<snip>

The rules lay out 10 broad categories of essential health benefits,
but allow each state to specify the benefits within those categories,
at least for 2014 and 2015. <snip>

The rules limit insurers’ ability to charge higher premiums based on age.
Under the rules, the rate for a 63-year-old could not be more than
three times the rate for a 21-year-old.
Many states now allow ratios of five to one or more, the administration said.<snip>

The rules also give employers new freedom to reward employees who participate
in workplace wellness programs intended to help them lower blood pressure,
lose weight or reduce cholesterol levels. <snip>

The rules include several provisions to prevent discrimination against employees.
Employers must, for example, allow workers to qualify for rewards in other ways
if it would be “unreasonably difficult” for them to meet a particular standard.<snip>

The new law seeks to protect consumers by limiting what they must
pay for health care before insurers begin to pay.
In the small-group market, these deductibles are limited to $2,000 for individuals
and $4,000 for family coverage.
<snip>