MIT Health Care Benefits: Ahead of Federal Health Care Reform

MIT understands that health insurance and other employer-sponsored benefits are a significant part of your total compensation, and we strive to offer you a comprehensive and competitive benefits package. The Patient Protection and Affordable Care Act (PPACA) is the federal legislation guiding federal health care reform. Below is a chart of the plan design changes that will be in effect in 2013. As you can see, MIT has offered many of the newly mandated benefits to our employees before the start of federal health care reform.

Benefit Feature Health Care Reform Requirements Through 2013 MIT Provides
Primary care providers Participants must be permitted to select any available provider in the plan’s network of providers. Likewise, children must be permitted to elect any available pediatrician in the plan as a primary care provider. MIT already permits participants to select any available plan primary care provider. Children may select a pediatrician as their primary care provider.
Emergency Must be covered without prior authorization and at an in-network level of benefits. MIT plans do not require prior authorization for emergency services; benefits will be paid at the in-network level beginning 1/1/13.
Well patient visits Must be available with no prior authorization, co-pay, or coinsurance required. MIT does not require prior authorization, coinsurance, or co-payment for in-network services.
Women's preventive health services Must be available with no prior authorization, co-pay, or coinsurance required. No prior authorization is required and there is no out-of-pocket cost to MIT participants for preventive obstetric and gynecological care received in network.
Pre-existing condition exclusions For children under age 19, pre-existing condition exclusions are not permitted. The MIT plans have no pre-existing condition exclusions.
Health Care Flexible Spending Account (Health FSA) contributions Maximum employee contribution to Health FSA changed to $2,500. The maximum contribution for the Health FSA will change as of 1/1/13 from $8,000 to $2,500.
Over-the-counter medication No longer an eligible Health Care FSA expense. As of 2011, over-the-counter medications are not an eligible expense for the MIT Health FSA, unless you have a written prescription from your provider.
Lifetime and annual limits Transitional limits are in place to gradually prohibit lifetime and limits on "essential benefits." Lifetime limits on essential benefits are expected to be completely prohibited in 2014. MIT does not have lifetime limits on essential benefits.
Dependent child coverage Plans that cover dependent children must cover eligible dependents through age 25 (until the child's 26th birthday). MIT health plans cover eligible dependent children through the end of the month in which they turn age 26.
Summary of benefit coverage (SBC) Standardized benefit descriptions will need to be distributed to all plan participants. MIT will have the SBCs available in November 2012.
FDA-approved contraception methods Plans are required to offer FDA-approved contraception methods without requiring the participant to pay a co-pay. Effective 1/1/13, MIT will comply with this new regulation.
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