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HHS Releases Guidance on Essential Health Benefits

On December 16, 2011, the Department of Health and Human Services (HHS) released initial guidance regarding the essential health benefits that plans offered in the exchanges will have to cover.  The Affordable Care Act set initial parameters for essential health benefits, dictating that insurance plans must cover 10 broad categories of services, such as hospitalizations and prescription drugs, and that the benefits should be similar to those offered in the typical employer plan.  The guidance is the first indication of how the administration will implement the essential health benefits statute. 


Broadly, the guidance suggests that states will be given discretion to choose a benchmark plan whose covered services will define the essential health benefits for plans offered in the state.  States can choose among one of the three largest small group, state employee, federal employee or HMO plans offered in the state.  They must pick a plan that includes all 10 statutory categories, regardless of what the benchmark plan does.  If a set of services isn’t included, such as mental health services, for instance, it must be added.


NHF is reviewing the guidance and will submit comments to HHS before the deadline at the end of January.  NHF will share its comment letter with chapters, which can use it in conversations with state policymakers.

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