Employers excluding outpatient surgery from insurance plans

Editor's Note

Last year, government regulators blocked large companies that employ many low-wage workers from claiming that insurance coverage with no inpatient hospital benefits met the Affordable Care Act’s rules. These same companies are now purporting to meet the rules with plans that exclude outpatient surgery, the January 21 Washington Post reports.

Large employers are not required to offer a list of “essential health benefits,” but instead must offer minimum value as determined by an online calculator and regulatory guidance, or face a penalty.

Before the Affordable Care Act, these employers (eg, staffing companies and hoteliers) never provided major medical coverage. 

Libbi Stovall couldn't believe it last month when she looked at the fine print in her company's 2016 health plan, which supposedly meets the strictest standard for employer obligations under Affordable Care Act rules. The insurance paid for inpatient hospital care, office visits and diagnostic imaging.