January 4, 2012

Department of Health and Human Services releases bulletin on essential health benefits

On December 15, the Department of Health and Human Services (HHS) released a summary and bulletin on its approach for essential health benefits. Under health care reform, fully insured individual and small group markets (inside and outside exchanges) must include the essential health benefits beginning in 2014. 

Instead of defining a specific benefit package or benefit rules, HHS’ summary and 15-page bulletin lets states choose one of the following plans as its benchmark plans for essential health benefits: 

· One of the three largest small group plans in the state by enrollment;

· One of the three largest state employee health plans by enrollment;

· One of the three largest federal employee health plan choices by enrollment; or

· The largest HMO plan offered in the state’s commercial market by enrollment.   

If a state chooses not to select a benchmark, HHS suggests that the default benchmark will be the small group plan with the largest enrollment in the state.   

Comments will be accepted until January 31. HHS will likely use these comments for a proposed and then final rule later in 2012. 

 

Health Care Reform — Important Updates