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:
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:
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?
Find out more about essential health benefits.
Find out more information on the Essential Health Benefits Bulletin.
This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.
Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.
For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.