HHS Posts Essential Health Benefits “Prerule” Bulletin

News from the Blues reports:

“On Friday, the Department of Health & Human Services (HHS) issued a “prerule” bulletin outlining how HHS intends to pursue rulemaking to define essential health benefits as required by the Affordable Care Act.

In the bulletin, HHS suggests it will accord states flexibility with regard to what “essential health benefits” insurers must offer in Qualified Health Plans, Medicaid state plans and certain other plans by 2014. Rather than establish a national standard, HHS would instead offer states a menu of benchmark plans that represent a “typical employer plan” as follows:

  • One of the three largest small group plans in the state by enrollment
  • One of the three largest state employee health plans by enrollment
  • One of the three largest federal employee health plan options by enrollment
  • The largest HMO plan offered in the state’s commercial market by enrollment

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

We will keep you informed as this and other activities related to the Affordable Care Act progress.”