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HHS decides on Essential Benefits recommendations

UPDATE – On December 16th, the Department of Health & Human Services (HHS) released a decision on the recommendation of “essential benefits” presented by the Institute of Medicine (IOM) on October 7th.  As previously noted, the IOM had presented recommended scope of services that should be included in the 10 health services categories that any plan offered through a state insurance exchange beginning in 2014 would have to provide benefits coverage.  HHS decided to offer the states flexibility in determining the essential benefits by allowing the states to select a scope of services offered by a “typical employer plan”.  The states can determine the “typical employer plan” by using one of four benchmarks:

• 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.

When the IOM released their recommendations last October, they recommended that the scope of services and benefit levels be comparable to the typical small group employer health plan.  Many proponents of the Affordable Care Act had proposed that HHS set the essential benefits scope of services as comparable to the typical federal employee health plan.  With the decision by HHS on December 16th, the decision is now left up to the states and there may be significant differences in the health plan scope of services offered by state in the insurance exchanges.

To view the HHS released decision of December 16th, please follow this link.

http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html