HHS: Essential benefits to be determined by states

Insurers are slowly inching toward knowing what essential benefits they must offer in plans sold through health insurance exchanges. But that doesn't mean they're any closer to learning about what specific benefits are actually required.  

The Department of Health & Human Services (HHS) is giving states almost complete flexibility to determine what essential benefits they will require as a condition of participation in their exchanges, according to a "pre-rule bulletin" the agency issued Dec. 16.

The health reform law lists 10 broad benefits categories that every plan sold through exchanges must provide, but it leaves the determination of specific requirements to HHS, which has decided to pass the decision on to the states, according to The Hill's Healthwatch.

The agency's decision means there won't be one national standard benefits package for insurers to comply with, but instead different "benchmark" plans in each state where they operate, reports Kaiser Health News.  

According to the bulletin, states must choose from one of four benchmark options provided by HHS--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 HMO plan offered in the state's commercial market.

HHS chose to issue the bulletin instead of a proposed regulation, so the guidance doesn't have the force of law, KHN notes. Also, HHS only addressed services and items covered by a health plan in its bulletin. The agency said it will address cost-sharing features, including deductibles, copayments and coinsurance, in future bulletins and rules.  

To learn more:
- read the HHS press release and bulletin (.pdf)
- here's The Hill's Healthwatch article
- check out the Kaiser Health News article

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