A recent report from consulting firm Avalere Health (pdf) broke down the latest news on how states are advancing toward essential health benefit benchmark plans for health insurance exchanges.
"Qualified health plans" will be the benchmark plans within health insurance exchanges, instituted by the Patient Protection and Affordable Care Act. EHBs are the scope of benefits covered by a typical employer plan and cover at least the following 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse, prescription drugs, rehab services, laboratory services, preventive and wellness care, and pediatrics.
Further, states must define EHBs by selecting a benchmark plan from four options: 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 plans by enrollment or the largest HMO plan offered in the state's commercial market by enrollment.
Here are five things to know on EHBs from Avalere's report.
1. Sixteen states, including Illinois, California and Vermont, and Washington, D.C., have already proposed EHB benchmark plans.
2. Sixteen states, including Texas, Arizona and New York, have identified potential EHB benchmark plans.
3. Eighteen states, including Wisconsin, Florida and Georgia, have made no progress toward EHBs.
4. Of the states that have identified EHB benchmark plans, most have chosen the small group plan as the blueprint.
5. HHS still must release final regulations on EHBs, although the timing of the final guidance is uncertain.
"Qualified health plans" will be the benchmark plans within health insurance exchanges, instituted by the Patient Protection and Affordable Care Act. EHBs are the scope of benefits covered by a typical employer plan and cover at least the following 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse, prescription drugs, rehab services, laboratory services, preventive and wellness care, and pediatrics.
Further, states must define EHBs by selecting a benchmark plan from four options: 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 plans by enrollment or the largest HMO plan offered in the state's commercial market by enrollment.
Here are five things to know on EHBs from Avalere's report.
1. Sixteen states, including Illinois, California and Vermont, and Washington, D.C., have already proposed EHB benchmark plans.
2. Sixteen states, including Texas, Arizona and New York, have identified potential EHB benchmark plans.
3. Eighteen states, including Wisconsin, Florida and Georgia, have made no progress toward EHBs.
4. Of the states that have identified EHB benchmark plans, most have chosen the small group plan as the blueprint.
5. HHS still must release final regulations on EHBs, although the timing of the final guidance is uncertain.
More Articles on Essential Health Benefits:
States Approach Deadline of Essential Health Benefits
Vermont Releases Outline of Health Benefits for Insurance Exchange
HHS Issues Final Rule on Data-Reporting to Define Essential Health Benefits