The Department of Health and Human Services (HHS) Wednesday released its long-awaited final rule on essential health benefits, allowing insurers and states to move forward on both the federal and state health exchanges. The rule defines what must be covered in exchange plans, prohibits discrimination based on age or pre-existing conditions, describes prescription drug benefits and determines levels of coverage.
The rule spells out the administration’s final core set of mandatory covered health benefits, and provides guidance on benefits required by the “Patient Protection and Affordable Care Act” that are not typically found in current employer benefit plans, as well as a standard method for computing the actuarial value of each health plan for consumer comparison purposes.
The essential health benefits include ambulatory patient services; emergency care; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and rehabilitative services and devices; laboratory services; preventive and wellness services, and chronic disease management; and pediatric services, including dental and vision care. Plans in the individual and small-group markets inside and outside of the health insurance exchanges must cover essential health benefits beginning in 2014.
The rule also sets a timeline for qualified health plans to be accredited in federally facilitated health insurance exchanges and amends regulations providing an application process for recognizing additional accrediting entities to certify qualified health plans.
The rule is set to be published in the Feb. 25 Federal Register. HHS received more than 11,000 comments before releasing its final regulations. For more on the rule, click on: http://tinyurl.com/a7nohax.
In addition, HHS released a report detailing how the rule applies to mental health and substance use disorder benefits and federal laws requiring that mental health benefits be provided at parity with other health benefits in the individual and small group markets. The report said the final rule’s parity provisions could affect some 62 million people.
“The Affordable Care Act helps people get the health insurance they need,” said HHS Secretary Kathleen Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”