Essential Health Benefits
On Dec. 16, 2011, the Department of Health and Human Services (HHS) issued a bulletinOpens a new window (PDF) setting forth its intended approach to further define the scope of the Essential Health Benefits that must be offered in the individual and small group markets as part of an Essential Health Benefit Package.
Under the Patient Protection and Affordable Care Act, there are 10 broad categories that encompass Essential Health Benefits. Under this proposed regulatory approach, states will have flexibility in determining the Essential Health Benefits. States will choose one of several benchmark plans which would then reflect the scope of services offered by a "typical employer plan." Benefits contained in the selected benchmark plan would become the Essential Health Benefits package in that state. Health plans are permitted flexibility in designing the benchmark plan so long as the plan is "substantially equal" to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories.
The bulletin provides information and solicits comments on the regulatory approach. HHS invited comments by Jan. 31, 2012.