Home » Blog » EHB FAQs

EHB FAQs

HHS released a list of FAQs as a follow-up to the Bulletin on rulemaking Essential Health Benefits (EHBs) released in December. The FAQs are intended to provide additional guidance on HHS’s intended approach on EHB defining.

Some main points:

  • States are not permitted to adopt different benchmark plans for its individual and small group markets. A state would select only one of the benchmark options as the applicable EHB benchmark plan across its individual and small group markets both inside and outside of the Exchange.
  • A process for updating EHB in future rulemaking will be proposed by HHS. Under the intended approach, the specific set of benchmark benefits selected in 2012 would apply for plan years 2012 and 2012.
  • If a benchmark plan is missing coverage in one or more of the ten statutory categories, the State must supplement the benchmark by reference to another benchmark plan that includes coverage of services in the missing category. For example, if a benchmark plan covers newborn care but not maternity services, the State must supplement the benchmark to ensure coverage for maternity services.
  • Under the ACA, self-insured group health plans, large group market health plans, and grandfathered health plans are not required to offer EHB. However, the prohibition in PHS Act section 2711 on imposing annual and lifetime dollar limits on EHB does apply to self-insured group health plans, large group market health plans, and grandfathered group market health plans.
  • HHS anticipates that selection of the benchmark plan for 2014 and 2015 would need to take place in the third quarter of 2012 in order to provide each State’s EHB package, which includes the benchmark plan, any State-supplemented benefits to ensure coverage in all statutory categories, and any adjustments to include coverage for applicable State mandates enacted before December 31, 2011.

Click here to read the rest of the FAQS.