HHS Issues Guidelines for States Regarding “Essential Benefits”

The Department of Health and Human Services issued much anticipated guidance today that will give states flexibility in determining what “essential benefits” insurers must provide in policies offered on the new health exchanges. The Affordable Care Act requires that insurers offer these “essential benefits” in most policies sold to individuals and small businesses.  HHS has decided that instead of implementing one national standard, states will be able to design benchmark plans based on one of four choices. These choices are: the benefits offered in one of the three largest federal employee plans (by enrollment), one of the three largest plans offered to the state’s employees, one of the three largest small-business plans in the state or the plan offered by the largest HMO in the state.

-Jaime Venditti, 12/16/11