Private Health Insurance Benefits

Private Coverage Under California's Affordable Care Act: Benefit and Cost-Sharing Requirements Affecting Children and Adolescents With Special Health Care Needs
by Peggy McManus and Harriette Fox, May 2013
This issue brief examines the extent to which California’s essential health benefits benchmark plan meets the needs of children and adolescents, including those with special needs. It also examines that cost-sharing requirements that will be used by health insurance plans sold in California’s Health Insurance Exchange. It identifies potential issues of concern in the benchmark’s essential health benefits, with special attention to families’ out-of-pocket cost liabilities within all five levels of coverage, including subsidized coverage.

Private Health Insurance for Adolescents: Is It Adequate?
by Harriette B. Fox, Margaret A. McManus, and Mary B. Reichman. Journal of Adolescent Health. 2003; 32: 12-24
This article examines the extent of private health insurance coverage available for services required by six hypothetical adolescents with different health conditions: asthma, attention deficit hyperactivity disorder, injury, major depressive disorder, pregnancy with sexually transmitted infections, and substance abuse with bipolar disorder. The analysis considers the availability of the benefit, access restrictions and protections relevant to the adolescent’s condition, and limits in amount and duration of coverage. Information for the study was obtained from contract documents for the most commonly sold HMO and PPO product in each state.