The Center for Consumer Information and Insurance Oversight within the Department of Health and Human Services (HHS) issued a bulletin on December 16 to provide information and solicit comments on HHS’s approach to defining Essential Health Benefits (EHB) under the Patient Protection and Affordable Care Act (ACA). The ACA requires non-grandfathered plans in the individual and small group markets, Medicaid benchmark and benchmark-equivalent, and Basic Health Programs to cover EHB beginning in 2014. The scope of EHB, as defined by HHS, must equal the scope of benefits provided under a “typical” employer plan. In the bulletin, HHS stated that it intends to define EHB through a benchmark plan that each state selects. Significantly, HHS intends to allow states to select a benchmark plan from among the following existing health plans:
- One of the three largest small group plans in the state;
- One of the three largest state employee health plans;
- One of the three largest federal employee health plan options; or
- The largest health maintenance organization in the state’s commercial market.
If a state fails to select a benchmark, the default would be the state’s largest small group market plan. Comments on the intended approach are due by January 31, 2012.