November 29, 2015

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.

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