December 16, 2011 Bulletin from HHS on Implementing Essential Health Benefits for Affordable Care Act Essential Health Benefits (EHB) = minimum coverage standards that health plans must meet beginning in 2014 Intended to ensure that consumers have access to adequate coverage & can make easy comparisons between insurance plans when purchasing coverage ACA has 10 categories of benefits required to be included in EHB & mental health and substance abuse disorders are included ACA did not specify which services must be covered in each of the 10 categories

Bulletin from HHS cont’d Rather than designing one standard benefit package for all health plans in the nation to follow, HHS has opted to leave the states with broad discretion in defining essential health benefits in their state This recent bulletin proposes to allow states four options for selecting a “benchmark” plan who covered benefits would be the basis for the EHS in the state. The four options are: -Any of the three largest small group plans in the state -Any of the three largest state employee health plans -Any of the three largest federal employee health benefits programs (FEHBP) options or -The largest insured commercial non-Medicaid HMO plan in the state If a plan that a state selects as its benchmark does not include all of the 10 required categories of benefits, then the plan must be modified to include the missing categories