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AFC to State Insurance Dept: Heath Plans Must Provide Solid HIV Benefits

March 28, 2013

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The AIDS Foundation of Chicago (AFC) submitted on March 27, 2013 comments to the Illinois Department of Insurance (DOI) on the standards insurance plans must meet to be included on the Illinois Health Insurance Marketplace.

The marketplace (also known as the exchange) will be an interactive website that will allow individuals and small businesses to purchase more affordable private health insurance. The marketplace was established by the Affordable Care Act (ACA), the national health care reform law.

 

 

AFC raised several specific issues:

 

  • DOI should not allow plans to charge unreasonably high cost-sharing for HIV medications.
  • DOI should clarify how health insurance plans should submit data about coverage of combination HIV medications. DOI's proposals would allow plans to include combination medications under several categories, making it difficult for DOI to determine if coverage is sufficient to meet the needs of people with HIV.
  • DOI should make sure plans include robust networks of safety-net providers, including agencies funded by the Ryan White Program. One proposed standard, which AFC deems unacceptable and urged DOI to delete, would allow plans to include less than 20% of safety-net providers in an area.  Under this unacceptable standard, plans would not be required to offer contacts to any Ryan White Program providers.

DOI is expected to release final guidelines on Monday, April 1.  Insurance companies must submit proposed plans by April 30.

Read AFC's full comments (PDF)

Read the draft DOI standards (PDF)

Categorized under Health insurance and Illinois.

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