News & Updates

New Guidance to Ensure Adequate Coverage
On December 16, 2011, the Center for Consumer Information and Insurance Oversight released an EHB Bulletin providing information on how to define EHB under the Affordable Care Act.

The Affordable Care Act ensures that customers have access to sufficient coverage that includes the following ten basic benefit categories:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

According to the Center for Consumer Information and Insurance Oversight, the least-covered categories of benefits among typical employer plans are: habilitative services, pediatric oral services, and pediatric vision services.

Further EHB Guidance
The U.S. Department of Health and Human Services (HHS) intends to propose that EHB would be defined using a benchmark approach. Rather than have one standard benefit package for everyone to follow, each state would define its own EHB. What's more, each state would have four options for selecting a benchmark plan:

• Largest plan by enrollment in any of the three largest small group insurance products in the state's small group market;
• Any of the largest three state employee health benefit plans by enrollment;
• Any of the largest three national Federal Employee Benefits Health plan options by enrollment; or
• Largest insured commercial non-Medicaid HMO operating in the state

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

What Health Plans Qualify?

• Plans offered in the individual and small group markets, both inside and outside of the exchange or Connector

Find out more about essential health benefits.

Find out more information on the Essential Health Benefits Bulletin.