Commencing in 2014, the Affordable Care Act requires health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Exchange, to offer a comprehensive package of items and services, known as Essential Health Benefits.
Under the Affordable Care Act (ACA), health plans must cover ten benefit categories called Essential Health Benefits (EHB) offered in the individual and small group markets, both inside and outside of Health Insurance Exchanges and Medicaid plans must also cover these services by 2014.
The EHB plan must take into account the health care needs of Minnesota’s diverse segments of the population, and may not discriminate based on age, disability, or expected length of life.
The EHB plan must include and set an appropriate balance between the ten specific categories of services listed below:
The EHB must also:
Selection of EHB “Benchmark Plan”
In order to implement the Essential Health Benefits, the U.S. Department of Health and Human Services (HHS) decided to use a benchmark approach for 2014 and 2015, allowing states to select a benchmark plan that reflects the scope of services offered by a “typical employee plan.” HHS identified four options of health plans, for states to select from to be the EHB “Benchmark Plan” for each state, or a default plan will be selected.
The four options for states to choose from, and the health plans for Minnesota that fulfill these options, are listed below:
HHS also determined that if states choose not to select one of the four options, then that state’s default plan will be the small group plan with the largest enrollment in the state. HHS has determined that the HealthPartners Small Group Product is the small group plan with the largest enrollment in Minnesota, and thus will be Minnesota’s default EHB Benchmark Plan. In addition, the Governor’s Health Reform and its Task Force Access Work Group reviewed this default plan and confirmed it contains all of Minnesota’s state mandated coverages.
HHS originally required a state’s selection by September 30, 2012 as part of a data request. However, HHS’s confirmation of the EHB Benchmark Plan has been postponed until December 26, 2012. The Commerce Department, in consultation with the Minnesota Department of Health, submitted information regarding Minnesota’s state mandated benefits to HHS as part of the September 30th data reporting request. At the time of this data request, Minnesota did not submit a choice from the four HHS options to be the state’s EHB Benchmark Plan. Thus, HHS indicated the HealthPartners Small Group Product as the default plan for Minnesota’s EHB Benchmark Plan in the Notice for Proposed Rulemaking released on November 26, 2012.
Who makes the EHB determination?
Where are we now?
November 26, 2012
HHS used the information reported by September 30 to prepare a Notice of Proposed Rulemaking (NPRM) where they reported the following:
On November 26, 2012, HHS defined Minnesota’s (largest small group plan) default EHB as: HealthPartners 500 25 Open Access PPO.
December 26, 2012
States may indicate their choice of EHB during the NPRM comment period, which closes on December 26, 2012.
After the NPRM comment period closes
If Minnesota does not choose an EHB during the NPRM comment period, HHS will apply the default as discussed above.