Health News
In December 2011, the Department of Health and Human Services released long-awaited regulations on the Essential Health Benefits (EHB). A major piece of the Affordable Care Act, EHB will define the minimum level of coverage that must be offered in plans sold to individuals and small businesses both inside and outside the new health benefits exchanges. Although the hope was that the EHB regulations would create a minimum level of coverage that would ensure equal coverage for all who purchase health insurance, the Federal government handed off the responsibility of defining the EHBs to the states.
The December 16, 2011 bulletin that handed off that responsibility also provided some guidelines for how to go about doing that. The ACA determined that the EHB plan must cover benefits from 10 categories:
The federal guidelines offer states a great deal of flexibility in defining their EHB plans. The plan that a state chooses will be supplemented to meet Federal standards before it is certified as the EHB plan. If, for instance, the selected benchmark plan is lacking coverage of the maternity category, the state would supplement by using the coverage of that category from another insurance plan currently available in that state. However, HHS offered no guidance as to which category certain benefits should be categorized under, leaving the content of categories a mystery.
Insurance companies, as well, have some flexibility in how they implement EHBs. Insurance plans must offer coverage that is ?substantially equal? to the coverage offered in the benchmark plan. Also, insurance plans can modify the coverage they offer within a category, and potentially between categories, as long as the federal government does not see the modification as a reduction in value of coverage.
How Will Illinois Define its Essential Health Benefits?
It is not yet clear what the Illinois EHB or benchmark plan will look like. Illinois? listing in the report of each states? three largest small business plans, released by HHS for the purposes of selecting a benchmark, is constituted by three plans offered by Blue Cross Blue Shield of Illinois: BlueAdvantage Entrpreneur PPO, BlueEdge HSA, and BluePrint PPO. However the federal government has not yet approved the pool of eligible benchmark plans for the state of Illinois. In some states, comparison of potentially eligible plans has revealed that most of these plans offer comparable coverage, but it is still unclear if that holds true for Illinois. Also, it is not clear if Illinois plans to define the state?s EHB and benchmark plans itself, or to default to the federal government.
Advocates in Illinois have begun the conversation around the issue of the state?s EHB plan. The American Cancer Society, with assistance from other advocacy groups, has called for the Illinois Department of Insurance to clarify the levels of coverage offered in the plans that will constitute the pool of possible plans: They have specifically asked for information on any non-monetary coverage limits that may exist in those possible plans, and have developed a survey tool that highlights 31 areas of coverage, in an attempt to what the Illinois benchmark plan could look like, and to better develop advocacy efforts in favor of a more comprehensive set of EHBs.
Check back here for additional news on Essential Health Benefits in Illinois...decisions have to be made by states by September 2012!
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Health News
Essential Health Benefits in Illinois - What's Next?
In December 2011, the Department of Health and Human Services released long-awaited regulations on the Essential Health Benefits (EHB). A major piece of the Affordable Care Act, EHB will define the minimum level of coverage that must be offered in plans sold to individuals and small businesses both inside and outside the new health benefits exchanges. Although the hope was that the EHB regulations would create a minimum level of coverage that would ensure equal coverage for all who purchase health insurance, the Federal government handed off the responsibility of defining the EHBs to the states.
The December 16, 2011 bulletin that handed off that responsibility also provided some guidelines for how to go about doing that. The ACA determined that the EHB plan must cover benefits from 10 categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management, and
- Pediatric services, including oral and vision care
- 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.
The federal guidelines offer states a great deal of flexibility in defining their EHB plans. The plan that a state chooses will be supplemented to meet Federal standards before it is certified as the EHB plan. If, for instance, the selected benchmark plan is lacking coverage of the maternity category, the state would supplement by using the coverage of that category from another insurance plan currently available in that state. However, HHS offered no guidance as to which category certain benefits should be categorized under, leaving the content of categories a mystery.
Insurance companies, as well, have some flexibility in how they implement EHBs. Insurance plans must offer coverage that is ?substantially equal? to the coverage offered in the benchmark plan. Also, insurance plans can modify the coverage they offer within a category, and potentially between categories, as long as the federal government does not see the modification as a reduction in value of coverage.
How Will Illinois Define its Essential Health Benefits?
It is not yet clear what the Illinois EHB or benchmark plan will look like. Illinois? listing in the report of each states? three largest small business plans, released by HHS for the purposes of selecting a benchmark, is constituted by three plans offered by Blue Cross Blue Shield of Illinois: BlueAdvantage Entrpreneur PPO, BlueEdge HSA, and BluePrint PPO. However the federal government has not yet approved the pool of eligible benchmark plans for the state of Illinois. In some states, comparison of potentially eligible plans has revealed that most of these plans offer comparable coverage, but it is still unclear if that holds true for Illinois. Also, it is not clear if Illinois plans to define the state?s EHB and benchmark plans itself, or to default to the federal government.
Advocates in Illinois have begun the conversation around the issue of the state?s EHB plan. The American Cancer Society, with assistance from other advocacy groups, has called for the Illinois Department of Insurance to clarify the levels of coverage offered in the plans that will constitute the pool of possible plans: They have specifically asked for information on any non-monetary coverage limits that may exist in those possible plans, and have developed a survey tool that highlights 31 areas of coverage, in an attempt to what the Illinois benchmark plan could look like, and to better develop advocacy efforts in favor of a more comprehensive set of EHBs.
Check back here for additional news on Essential Health Benefits in Illinois...decisions have to be made by states by September 2012!
- Anthem Ppo Plan Chosen As 'benchmark' For State's Kentucky Health Benefit Exchange
The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the ?benchmark? plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued...
- Doi Moves To Allow Consumers To Continue Current Coverage Into 2014
The Illinois Department of Insurance (DOI) announced on November 22 that it will follow President Obama?s November 14 recommendation and allow insurance companies to renew a number of health plans in the individual and small group markets that do not...
- One Step Closer To Knowing - Doi Issues Qhp Guidance
Under the Affordable Care Act, one of the new options for individuals and small businesses to buy health insurance for themselves and their employees in 2014 will be the Illinois health insurance exchange or "marketplace." On March 29, 2013, the...
- Illinois Essential Health Benefits Benchmark Plan
The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan. This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits"...
- Essential Health Benefits: What?s It Mean For People With Hiv?
On December 16, 2011, the U.S. Department of Health and Human Services (HHS) announced that states would decide what essential health benefits will be provided under health care reform. Although we had urged HHS to adopt a uniform, national benefits...