Group Medical Expense Provisions and the AIDS Crisis

Abstract

An exploration of the provisions of group medical expense plans that play the most significant part in determining coverage for acquired immune deficiency syndrome (AIDS) patients presents the following crucial elements in measuring the extent of health care coverage available: 1. maximum limitations on lifetime expenditures, 2. hospice care, 3. home health care, 4. experimental treatments, 5. prescription drug coverage, 6. mental health benefits, 7. continuation benefits, 8. leaves of absence, and 9. preexisting condition clauses. Benefit managers need to monitor changes and additions to this list as a way of forecasting the rate of medical cost inflation. As a result of AIDS, several changes among medical plan benefits are predicted: 1. Self-insured financing will decline. 2. Coverage for home health care and hospice services will continue to rise. 3. Employers will formalize policies concerning leave of absence. 4. Coverage for outpatient prescription drugs will be scrutinized carefully. 5. The decline in coverage for mental benefits will slow. 6. The most contentious area of potential benefit redesign activity will be the preexisting-condition clause.