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HHS Provides Benchmarks for Essential Health Benefits by Providing List of Products with Three Largest Enrollments in Small Group Market in Each State; Comments Still Due January 31
The Department of Health and Human Services (HHS) provided illustrative information to complement its December 16, 2011 bulletin on essential health benefits (EHB) under the Affordable Care Act. The information provides the names of the three largest products in the small group market in each state ranked by enrollment. In addition, HHS provided a list of the top three nationally available Federal Employee Health Benefit Program plans based on enrollment. The information is being provided to facilitate a better understanding of the intended approach to EHBs. HHS is still collecting and reviewing public comment on its December 16 EHB bulletin (Comments are due January 31) and will subsequently release regulations.
(Updated January 26, 2012)
The Department of Health and Human Services (HHS) released a bulletin outlining the items and services known as "essential health benefits." The bulletin describes the approach that HHS intends to pursue in rulemaking to define these essential health benefits.
Under the HHS approach, states would be able to select an existing health plan to set as a benchmark for the items and services included in the package. The options would be:
- one of the three largest small group plans in the state;
- one of the three largest state employee health plans;
- one of the three largest federal employee health plan options;
- the largest HMO plan offered in the state's commercial market.
Plans could modify coverage as long as they do not reduce the value of coverage. States must also ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services and prescription drugs.
Comments on the outlined approach are due January 31, 2012.
Additional information:
Fact sheet
ASPE Issue Brief - summary of individual market coverage
ASPE Research Brief - information on comparing benefits in small group products and state and Federal employee plans
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