A proposed rule from the Department of Health and Human Services would establish data collection standards for insurers to demonstrate that they are offering certain health plans with “essential health benefits coverage” as defined under the Affordable Care Act. The rule also would begin a two-phase process for certifying such plans.
The health reform law requires non-grandfathered plans in 2014 to offer essential health benefits covering at least 10 categories of items and services. These include ambulatory, emergency, hospitalization, maternity/newborn, mental health/substance abuse, prescription drug, laboratory, preventive/wellness, chronic disease management, and pediatric services that include oral and vision care.
Essential health benefits, according to the rule, “will promote predictability for consumers who purchase coverage in these markets, facilitate comparison across health plans, and ensure that individual and small group subscribers have the same access to the same scope of benefits provided under a typical employer plan.”
The proposed rule is available here until publication June 5 in the Federal Register.
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