HHS releases bulletin on essential benefits, allows for state flexibility

Posted on December 16, 2011 | No Comments
Filed under Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Office of Consumer Information and Insurance Oversight, Office of the Secretary, Rulemaking, Rules, and Guidance

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The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States’ judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:

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 options by enrollment
The largest HMO plan offered in the State’s commercial market by enrollment

If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State.

For more information on Essential Benefits, click here.

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