In December the Department of Health and Human Services outlined proposed policies defining what exactly are "Essential Health Benefits" to be included in health plans. All insurance policies must cover these services in order to be certified and offered in the exchanges. Below are a list of those services:
Ambulatory Patient Services
Emergency Services
Hospitalization
Maternity and Newborn Care
Mental Health and Substance Abuse Disorders
Prescription Drugs
Rehabilitative and Habilitative Services
Lab Services
Preventive and Wellness Services, Including Chronic Disease Management
Pediatric Services, Including Oral and Vision Care
Each state would need to select a "Benchmark Plan" which could include at least all of the services above. Could be from the largest plan in the state, largest state plan, largest federal plan, largest hmo plan offered in state. This is the HHS's way of saying we are flexible. If the state does not elect their own, the default benchmark plan will be the small group plan with the largest enrollment in the state.
This "benchmark plan" is not to be confused with "Minimal Essential Coverage" which if you have more than 50 employees, could determine whether your health plan could set you up (or help you avoid) a big penalty from the fed. More to come later on that...........
So basically this means that all health plans would need to include an array of services in each of those ten areas identified in order to be offered through the state exchanges.
