07/18/2013
Curious about what the Essential Health Benefits for the Affordable Health Care Act? Here is a great article.
ESSENTIAL HEALTH BENEFITS
Friday, March 15, 2013
What are essential health benefits?
Established by the Patient Protection and Affordable Care Act (ACA), essential health benefits (EHB) is a set of health care service categories that must be covered by health plans offered in the individual and small group markets, both inside and outside of health insurance exchanges, starting Jan. 1, 2014. Medicaid plans and Basic Health Programs will also be required to cover the EHB. The reform law further requires these health plans to phase out all annual dollar limits on essential health benefits by Jan. 1, 2014.
Grandfathered, middle market and large groups are not subject to EHB requirements.
What categories are included in essential health benefits?
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Are health plans required to cover essential health benefits at a certain level?
In addition to offering the EHB, health plans will be required to meet specific actuarial values (AV). Actuarial value means the percentage paid by a health plan of the total allowed costs of benefits. Plans that are subject to EHB requirements must meet one of the following actuarial values: 60 percent for a “bronze plan;” 70 percent for a “silver plan;” 80 percent for a “gold plan;” and 90 percent for a “platinum plan.” These AVs, called “metal levels,” are intended to assist consumers in comparing and selecting health plans by allowing consumers to compare the relative payment generosity of available plans.
Is there a national standard for essential health benefits?
No. HHS is allowing each state to choose a benchmark plan. In general, whatever benefits the benchmark plan covers within the 10 categories above will be deemed the essential benefits for all individual and small group plans in that state. If a state chooses a benchmark plan that does not cover services in a required category, that benchmark must be supplemented, in many cases by adopting benefits from any other possible benchmark plan.
- See more at: http://www.medicahealthreform.com/exchangesonline-marketplaces/essential-health-benefits/ .SkfXkWF0.dpuf
What are essential health benefits?Established by the Patient Protection and Affordable Care Act (ACA), essential health benefits (EHB) is a set of health care service categories that must be covered by health plans offered in the individual and small group markets, both inside and outside of health...
