MCHPRC: Publications

	Publications

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Private Health Insurance

Reports:

Private Health Insurance for Adolescents: Is It Adequate?
by Harriette B. Fox, Margaret A. McManus, and Mary B. Reichman. Report, 28 pages, September 2002, $40.00.
This report 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 STD, 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.

The Strengths and Weaknesses of Private Health Insurance Coverage for Children with Special Health Care Needs
by Harriette B. Fox, Margaret A. McManus, and Mary B. Reichman. Report, 62 pages, January 2002, $55.00.
This report presents findings from a detailed analysis of private health insurance benefits for services important to children with special health care needs. The report examines the extent of plan coverage available for services required by six hypothetical children with different chronic conditions: asthma, attention deficit hyperactivity disorder, cerebral palsy, major depressive disorder with attempted suicide, spina bifida, and substance abuse with bipolar disorder. The analysis considers the availability of the benefit, access restrictions or protections relevant to the child´s particular condition, and limits in amount and duration of coverage. The report also provides a review of plan coverage policies for 22 medical, behavioral health, and specialized health services. Detailed tables on benefit limits and coverage requirements as well as cost-sharing provisions are included. Information for the study was obtained from contract documents for the most commonly sold HMO and PPO products in each state.
Download a free pdf of this report.
Private Health Insurance Coverage for Children: A Survey of 450 Employers
by Margaret A. McManus, Harriette B. Fox, Michael Perry, Evan Stark, and Susan Kennel. Report, 22 pages, February 1999, $25.00.
This report presents the findings from a nationally representative survey of 450 small, medium, and large employers conducted in September 1998. It addresses three topics on children´s health insurance coverage: employer perspectives and employee decisions regarding health insurance coverage for children, employer premium contributions and scope of coverage for children´s coverage, and future directions in employer-based coverage for children.
Download a free pdf of this report.
An Analysis of Preventive and Developmental Service Coverage in Private Health Insurance Plans
by Margaret A. McManus, Harriette B. Fox, and Dominique G. Kim. Report, 7 pages, February 1999, $10.00.
This brief report presents a description of private health insurance benefits for preventive care and developmental support services for families with young children. The information is derived from an analysis of the standard group policies in effect for 80 of the largest HMOs and PPOs in the United States in 1998. Services analyzed include: preventive care, comprehensive risk assessments, telephone advice lines, parent education, parent counseling, home visiting, and case management.

The Potential for Crowd Out Due to CHIP: Results from a Survey of 450 Employers
by Harriette B. Fox and Margaret A. McManus. Fact Sheet No. 3, 4 pages, March 1998, $10.00.
This fact sheet analyzes 1998 survey results from 450 small, medium, and large employers regarding their likely responses to CHIP. It also includes a variety of state strategies to prevent employers from eliminating or reducing coverage for CHIP-eligible children.
Download a free pdf of this report.
Articles:

A National Study of Commercial Health Insurance and Medicaid Definitions of Medical Necessity: What Do They Mean for Children?
by Harriette B. Fox and Margaret A. McManus. Ambulatory Pediatrics. Vol. 1, No.1, pp.16-22, January 2001.
This article analyzes the medical necessity criteria used by each state´s HMO and PPO enrolling the largest number of commercially insured individuals and by each state´s Medicaid agency that contracts with managed care organizations to serve Medicaid participants. Definitions were analyzed according to the scope of health problems covered, evidence of effectiveness required, and cost restrictions imposed. Information was obtained through analysis of commercial health insurance and Medicaid contract documents.

Private Health Insurance Coverage of Preventive Benefits for Children
by Margaret McManus and Karen Hertz. Child Health Supervision: Analytic Studies on the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Care Services for Infants, Children, and Adolescents. Washington, DC: George Washington University, Center for Health Policy Research, 1995.
This book chapter analyzes what preventive care benefits are covered by employers who offer HMO and non-HMO plans and what preventive care coverage questions are asked in the major employee benefit surveys. Also included are recommendations for improving benefit survey questions on preventive care for children.

Three Options for Providing Health Coverage to Children
by Paul Newacheck, Margaret A. McManus, and Harriette B. Fox. Providing Universal Health Insurance Coverage To Children: Four Perspectives. Princeton, NJ: The Robert Wood Johnson Foundation, 1996.
This report examines three policy options for expanding health insurance to all children. The first option is a state-run premium subsidy program for the uninsured. The second option is a Medicaid buy-in program for the uninsured and a new public wraparound health insurance plan for specialized services. The third option is a state and community formula grant program offering communities direct control over their children´s health care.