SPRINGFIELD, Ill.—Illinois officials chose a relatively lean small-group policy as the benchmark plan for essential health benefits in the state under the Patient Protection and Affordable Care Act. Gov. Pat Quinn's healthcare council approved Blue Cross and Blue Shield's Blue Advantage plan as the benchmark at a meeting in Chicago. It will be submitted to HHS, which will take public comment. The benchmark acts as a minimum standard for the type of medical services that must be covered in plans sold to individuals and small businesses under the law. The Illinois governor's council also approved benchmarks for children's vision and dental care, which must be covered under the federal law but aren't currently covered by most Illinois policies.
The Affordable Care Act set 10 basic categories that must be covered by health plans, such as emergency services, prescription drugs and maternity care, and within those categories, states determine a basic level of covered services and costs. The Blue Advantage plan is one of the leaner small-group health policies sold in the state, said Colleen Burns of the Illinois Department of Insurance. It puts a $1,000 annual limit on care from chiropractors. It covers only “medically necessary” weight-loss surgery. It doesn't cover routine vision or hearing exams for adults. The governor's office asked a group of doctors to review the health policies under consideration, focusing on their service limits and exclusions, Burns said.