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An important component of health reform implementation is the imposition of an “essential benefits” package (of health goods and services that insurers of groups and individuals must cover). Under the Patient Protection and Affordable Care Act (PPACA), that benefit package will be de rigueur (1) for policies sold on exchanges and (2) insurers of small groups. HHS has been busy defining this package, and in a Dec. 16 bulletin, announced its plans for defining essential benefits under Section 1302 of PPACA.
Employers are watching the development of essential benefits; some must be interested to see whether this adds fuel to health-price inflation. Even self-insured and grandfathered health plans (which are not required to offer an essential benefits package) are avid spectators because they might indirectly be impelled toward covering the essential benefit one day (if they do not already do so).
Employers that welcome the change and those that see it as a new source of health costs can comment on the bulletin by Jan. 31.
This bulletin reviews research on health care services covered by employers today, and then describes the approach HHS plans to propose. Plan cost sharing and the calculation of minimum actuarial values for employer-sponsored coverage were not addressed in this bulletin. HHS will deal with those two issues soon, it said.
The agency will use a more local reference plan based on employer-sponsored coverage in specific states. The feds say they are keeping an eye on affordability and state flexibility as well as rich benefits.
Table of Contents:
- Defining Essential Health Benefits
- A. Introduction and Background
- Statutory Provisions
- Public and Other Input
- B. Summary of Research on Employer Sponsored Plan Benefits and State Benefit Mandates
- Similarities and Differences in Benefit Coverage Across Markets
- Mental Health and Substance Use Disorder Services
- Pediatric Oral and Vision Care
- Habilitative Services
- Comparison to Other Employer Plan Surveys
- State Benefit Mandates
- Four Benchmark Plan Types
- Defraying the Cost of Additional Benefits
- Benchmark Plan Approach and the 10 Benefit Categories
- Habilitation
- Pediatric Oral and Vision
- Mental Health and Substance Use Disorder Services and Parity
- Benefit Design Flexibility
- Updating Essential Health Benefits
- C. Intended Regulatory Approach