States received more guidance Wednesday from the U.S. Department of Health and Human Services (HHS) about what the essential health benefits package for plans offered in states’ health insurance exchanges should look like.
In December, HHS released its first guidance to states on this critical part of the insurance exchanges, mandated under the Affordable Care Act. Insurance plans sold on the exchanges must cover 10 areas of care, including areas such as emergency care, maternity and pediatric care, mental health and prescription drugs.
On Wednesday, HHS released three federal plans and three small-group plans from each state that could serve as the benchmark for an essential health benefits package. However, the department did not include what kind of coverage those plans offer for the 10 areas. State health officials will likely have to study each plan’s full insurance package individually to determine what benefits they provide for the 10 areas required to be covered. “It’s a lot of legwork,” Joy Wilson, health policy director at the National Conference of States Legislatures, said.
States are given some flexibility in deciding what their package’s benchmark will be. They could choose between the three largest insurance plans for federal employees, the three largest small-group plans in the state by enrollment, the three largest state-employee plans and the largest HMO plan operating in the state.
Guidance on deductibles, premiums and other financial aspects of exchange plans will be released in the future, HHS said in December.
The plans selected by HHS are listed on pages 3 through 10 in the document below.