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NHF Comments on Essential Health Benefits Regulation

In November 2012, the Department of Health and Human Services (HHS) released a long-awaited proposed rule to implement the Affordable Care Act provisions concerning the Essential Health Benefits (EHB) and other private insurance reforms.  NHF has been closely monitoring EHB implementation, since this policy will help to ensure that new individual and small group health insurance plans offer comprehensive coverage in 2014 and beyond.  Our goal is to ensure that the EHB rule is defined to include the benefits that matter most to people with bleeding disorders.  For more information on the EHB, click here.

NHF sent two comment letters, together with other patient advocacy organizations, on the proposed rule.  Both letters emphasized the need for access to:

·         a robust formulary of drugs covered under the pharmacy and medical benefits;

·         a timely appeals process so enrollees can access drugs not covered by the plan; and

·         the need for out-of-network spending on drugs and services to count toward the out-of-pocket maximum limiting how much enrollees spend each year; among other concerns. 

To see the letter that NHF sent with the American Plasma Users Coalition (APLUS), which includes organizations representing people who use plasma-derived and recombinant products, click here.  To see the letter that NHF sent along with 150 other patient advocacy groups from across the healthcare spectrum, click here.

NHF will continue to monitor the implementation of EHB and other private insurance reforms. We will keep you informed on developments that affect the bleeding disorders community.

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