Essential Benefits More Flexible for States
Today the U.S. Department of Health and Human Services (HHS) announced through a press release that state exchanges will now determine their benchmark for essential benefits based upon use of the most popular plans in their region and the 10 benefit categories of care that were originally defined in the health care reform regulations. With this new approach, a state exchange will select an existing plan to serve as the standard for the items and services that will be included in the essential benefits.
The existing plan selected 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
- Or, the largest HMO plan offered in the state’s commercial market.
This change to move the responsibility of essential benefits to the state level will give states the flexibility to match their exchange plans to those offered by a typical employer in the state. Further, states that have a more broad based health care coverage mandate will not be penalized for incorporating their states' mandates into their definition of essential benefits. Overall, this announcement will ensure that each state will now be able to properly meet the needs of the residents of their state through the selections of health care coverage that they offer through their exchange.
HHS indicated that additional announcements will follow in the coming days to address exchange topics such as; cost share, deductibles, coinsurance and copayments. BenefitMall will continue to follow this story as more information is released on these topics. Click here to view today’s full HHS press release.
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The views expressed in this Legislative Alert do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.