Related Links

A final rule from the Department of Health and Human Services sets specific standards for individual and small-group coverage of health plans offered through health insurance exchanges, also called marketplaces.

The rule requires non-grandfathered health plans in the individual and small-group markets to cover “essential health benefits” in 10 categories, such as hospitalization, prescription drugs, and maternity/newborn care. Each state can select a benchmark plan--from a federal list--to serve as the standard for plans required to offer essential health benefits.

The essential health benefits include coverage for mental health and substance abuse treatment. Today, about 20 percent of the plans presently offered in the individual and small market categories don’t include mental health coverage, and a third don’t cover substance abuse programs, according to HHS.

The rule also sets four levels, or actuarial values, to rank the comprehensiveness of coverage in the plans, aiding consumer comparisons. The rule is available here with publication on Feb. 25 in the Federal Register.