Academic journal article Monthly Labor Review

Preventive Care Provisions, Other Benefits: Are They Described in Plan Documents? It Is Not Very Common for Preventive Care Provisions, Such as Cancer Screening Tests, to Be Specifically Mentioned in Plan Documents; These Benefits Are Usually Covered under a More General Clause. (Preventive Care, Other Benefits)

Academic journal article Monthly Labor Review

Preventive Care Provisions, Other Benefits: Are They Described in Plan Documents? It Is Not Very Common for Preventive Care Provisions, Such as Cancer Screening Tests, to Be Specifically Mentioned in Plan Documents; These Benefits Are Usually Covered under a More General Clause. (Preventive Care, Other Benefits)

Article excerpt

Provisions in medical care plans that emphasize coverage for preventive care tests have risen sharply in recent years. (1) The attention generated by such preventive care measures as cancer screening and cholesterol tests led the Bureau of Labor Statistics (BLS) and the Agency for Healthcare Research and Quality (hereafter, called Healthcare Research) to conduct a joint study to determine if employer health insurance documents specifically describe certain medical provisions. The study was conducted under the auspices of the Interagency Committee on Employment-Related Health Insurance Surveys. The primary motivation behind the test was the need for more information on preventive care services, as expressed by the U.S. Preventive Services Task Force. (2)

The Committee was formed as a means for Government agencies to coordinate statistical survey data related to health insurance, share information, and identify and fill data gaps. (3) Since its inception in 1998, the Committee's coordination efforts have focused on collection, analysis, and dissemination of statistical estimates. In addition to the Government agencies that produce health insurance statistics, the Committee's efforts are geared toward the wider data-user community and health policymakers.

How the test was conducted

The Agency for Healthcare Research and Quality role. The joint study by Healthcare Research and BLS Was undertaken in several steps. Initially, Healthcare Research identified medical care provisions that it was interested in studying, data for which BLS does not presently collect. These provisions include various cancer screening and other preventive care tests, and medical procedures, such as laser eye surgery, that have become more prominent in recent years. Next, Healthcare Research conducted three separate studies to collect preliminary information on these provisions from plan documents collected as part of its 1996 household and establishment surveys. (4) The main purpose was to provide feedback on information available from booklets to assist with additional study and to develop a data collection form for use by BLS. As a result of this study, definitions of terms and the design of the collection form were refined, and the list of provisions to be included in the BLS study was expanded.

The first study consisted of 31 booklets randomly selected from those collected during the Healthcare Research 1996 health survey, booklets that described medical care provisions. The second study included 100 booklets; however, about half were eliminated because of limited information on benefit provisions. In order to be used in the Healthcare Research study, plan booklets had to describe the benefits in some detail. The third and final study used a sample of 75 plans. The requirements to be included in this study were not as stringent as in the second study. For example, if a summary sheet was provided that gave limited details of the benefits, it would be included in the third study (but not included in the second). After Healthcare Research completed its preliminary studies, BLS conducted the official study using the final version of the collection form, which included definitions of each of the provisions.

The BLS role. The BLS study was conducted during its 2000 survey of private employee benefits. (5) The study consisted of a sample of 100 medical care plans; they were randomly selected using only the booklets that described the plans in the most detail. Summary plan descriptions (SPDs) furnished by the employer are the main source used in the benefits survey. Healthcare plan sponsors are required by law to provide SPDs to plan participants, giving the employees a detailed description of their benefits under a particular plan. (More details on SPDs are discussed later.) Documents with only limited information--such as one-page summaries--were excluded from the study. …

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