Today, HHS released its final rule outlining the essential health benefits insurers must provide for health plans operating in the health insurance exchanges. A copy of the final rule is available here.
Why are these rules important? Under the Affordable Care Act (ACA), beginning in 2014 every state will have a health insurance exchange – a marketplace in which individuals and employers will be able to purchase comprehensive health insurance. Plans participating in the exchanges must provide certain benefit (“essential health benefits”) within 10 specific categories: prescription drugs; ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; rehabilitative and habilitative services; laboratory services; preventive and wellness services; and pediatric services, including dental and vision care. The final rules issued today provide additional guidance on standards related to these essential health benefits.
For more information, check out these links:
The press release is live here: http://www.hhs.gov/news/press/2013pres/02/20130220a.html
The rule is live here: http://www.ofr.gov/(X(1)S(vp32o25ckyhpvspfpzx3owe4))/OFRUpload/OFRData/2013-04084_PI.pdf
The ASPE Issue Brief is live here: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm
The EHB fact sheet is live here: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html
And the Tri-Dept FAQs are live here: http://cciio.cms.gov/resources/factsheets/aca_implementation_faqs12.html