Essential Health Benefits
HHS (CCIIO) issued a New list – April 8, 2015—of the largest 3 small group insurance products by state.
Non-grandfathered plans in the individual and small group markets (both inside and outside of the Marketplaces) must cover “essential health benefits” (EHB).
The scope of EHB shall equal the scope of benefits provided under a typical employer plan.
Under current guidance from HHS, each State selects a benchmark plan that serves as a reference plan. It must include all 10 categories of EHB, or it must be supplemented to include them.
HHS issues lists of plans from which each state can select its benchmark plan. Each state’s selection is effective for a three-year period.
States can choose a benchmark plan from among the following health insurance plans:
- the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;
- any of the largest three State employee health benefit plans by enrollment;
- any of the largest three national FEHBP plan options by enrollment; or
- the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.
SO WHAT’S NEW?
On April 8, 2015, HHS issued lists of the following plans, based on enrollment in the first quarter of 2014.
- the three largest small group insurance products by state,
- the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans,
- the single largest Federal Employees Dental and Vision Insurance Program (FEDVIP) dental and vision plans respectively,
The first quarter 2014 enrollment data is collected through HealthCare.gov. HHS collects data (self-reported)from issuers of individual and small group major medical insurance
on their products, as required by the Affordable Care Act.
HHS intends to use this benchmark approach at least through plan year 2017.
Below is the information for CA, MT and UT. Click on the link above for all the states and the other lists.