Deadline for comments on essential health benefits is January 31

Tomorrow (January 31) is the deadline for submitting comments to the Department of Health and Human Services (HHS) on the essential health benefits bulletin, which HHS issued on December 16, 2011.

You can send your comments to: EssentialHealthBenefits@cms.hhs.gov

The bulletin outlined the approach HHS intends to pursue in rulemaking to define essential health benefits. As you may recall, the Patient Protection and Affordable Care Act (ACA) requires health insurance plans offered in the individual and small group markets, both inside and outside the Affordable Insurance Exchanges (Exchanges), to offer a comprehensive package of items and services, known as essential health benefits (EHB).

In the bulletin, HHS gave states the flexibility to decide what EHBs must be included in coverage sold to individuals or small businesses in the Exchanges. The law mandates coverage within ten benefit categories, but it is up to each state to decide the specifics, such as how many doctors’ visits or what drug services the plans will be required to offer. States can use several options to base those benefit requirements, including what some existing health plans in the state offer.

Choosing a benchmark. States are allowed to select an existing health plan as a "benchmark" for items and services in their EHB packages. If a benchmark does not cover one of the ten benefit categories, it must be supplemented, the HHS advises. Four health insurance plan options were given for choosing a benchmark, one of which was the choice of the largest plan (by enrollment) in any of the three largest small-group-insurance products in a particular state’s small group market.

Last week, HHS released a list of those three products for each state, but it cautions that it is for illustrative purposes only, and is not an official list of products that will be states’ benchmark options.