Health and Human Services (HHS) - Essential Health Benefits Rule Finalized
Today, HHS released its final rule outlining the essential health benefits insurers must provide for health plans operating in the health insurance exchanges. A copy of the final rule is available here.
Why are these rules important? Under the Affordable Care Act (ACA), beginning in 2014 every state will have a health insurance exchange – a marketplace in which individuals and employers will be able to purchase comprehensive health insurance. Plans participating in the exchanges must provide certain benefit (“essential health benefits”) within 10 specific categories: prescription drugs; ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; rehabilitative and habilitative services; laboratory services; preventive and wellness services; and pediatric services, including dental and vision care. The final rules issued today provide additional guidance on standards related to these essential health benefits.