Federal Government Releases List of Health Benefits Insurers Must Offer

NCPA February 21, 2013

The Obama administration issued its long-awaited final rule on essential health benefits that insurers must offer consumers in the individual and small-group market beginning in 2014 under the health care reform law, says Reuters.

• A cornerstone of President Barack Obama's plan to enhance the breadth of health care coverage in the United States, the mandate allows the 50 states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal health care exchanges.
• The rule included few changes from previous administration proposals, a fact that could help states and insurers as they prepare for new online state health insurance marketplaces, known as health care exchanges, scheduled to begin enrolling beneficiaries for federally subsidized coverage on October 1.
• The exchanges are expected to cover as many as 26 million people within 10 years and seem likely to dominate individual and small-group insurance markets.
• Another 12 million people are expected to receive health care coverage through an expansion of the Medicaid program for the poor, according to the Congressional Budget Office.

The Affordable Care Act sets out 10 benefit categories that must be covered by most plans at the same level as a typical employer plan. The categories range from hospitalization to prescription drugs to maternity and newborn care.

Insurers will use the government's final word on these required benefits as they design plans and set premium prices ahead of the exchange launches.

The administration also gave insurers the chance to phase-in requirements for plans sold on federally facilitated exchanges and denied requests from groups that wanted to exempt low-cost community health plans and Medicaid managed-care plans from the accreditation process.

Source: David Morgan, "U.S. Releases List of Health Benefits Insurers Must Offer," Reuters, February 20, 2013.