Transcript Slide 1

December 16, 2011 Bulletin from HHS on
Implementing Essential Health Benefits for
Affordable Care Act
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Essential Health Benefits (EHB) = minimum
coverage standards that health plans must
meet beginning in 2014
Intended to ensure that consumers have
access to adequate coverage & can make easy
comparisons between insurance plans when
purchasing coverage
ACA has 10 categories of benefits required to
be included in EHB & mental health and
substance abuse disorders are included
ACA did not specify which services must be
covered in each of the 10 categories
Bulletin from HHS cont’d
Rather than designing one standard benefit package for all health
plans in the nation to follow, HHS has opted to leave the states
with broad discretion in defining essential health benefits in their
state
 This recent bulletin proposes to allow states four options for
selecting a “benchmark” plan who covered benefits would be the
basis for the EHS in the state. The four options are:
-Any of the three largest small group plans in the state
-Any of the three largest state employee health plans
-Any of the three largest federal employee health benefits
programs (FEHBP) options or
-The largest insured commercial non-Medicaid HMO plan in the
state
If a plan that a state selects as its benchmark does not include all of
the 10 required categories of benefits, then the plan must be
modified to include the missing categories
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