On April 15 the Department of Labor issued a report (pdf) on employer-sponsored health insurance coverage, as required by the Affordable Care Act. The purpose of the report is to help the Department of Health and Human Services (HHS) determine which health benefits are to be considered “essential” and therefore must be offered by “qualified health plans” under the new law.

The Affordable Care Act imposes certain limitations on restricting the annual and lifetime dollar limits for essential health coverage. Under the new law, the annual limit restrictions will be gradually phased out, and by 2014, all employer plans, new individual market health plans, and those plans offered in the health insurance exchanges will be prohibited from imposing such dollar value limitations. The HHS issued interim final regulations on these limitations in June, 2010. The regulations did not, however, fully define what constitutes an “essential health benefit.” The health care reform law mandates that the HHS issue a more comprehensive definition for this phrase, and assure that these essential benefits are comparable to those offered by typical employer health benefit plans. To help the HHS achieve this goal, the Affordable Care Act directs the DOL to provide typical employer-sponsored health coverage data to the agency.

In a letter (pdf) attached to the DOL’s report, Labor Secretary Hilda Solis explains that the survey presents data from a sample of about 3,900 private-sector employers, and that the results were drawn from the National Compensation Survey (NCS) conducted in 2008 and 2009. The first section of the report summarizes the findings of these two surveys, describing the types of plans offered by employers, the overall plan limits, the types of services covered by these plans, and the amount of cost-sharing involved.

The second portion “presents new results from an analysis of additional health benefits, not included in the previously published reports, for which adequate information was available.” These additional services include: emergency room visits, ambulance services, diabetes care management, kidney dialysis, physical therapy, durable medical equipment, prosthetics, maternity care, infertility treatment, sterilization, gynecological exams and services, and organ and tissue transplantation.

More information on the survey results and methodology can be found here.

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