Reviewing Your State’s Essential Health Benefits (EHB) Benchmark Plan Selection

On November 20th, the Department of Health and Human Services (HHS) released the Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation proposed rule (?Rule?), which outlines the policies and standards for coverage of EHBs in the individual and small group markets.1 HHS defines EHB based on a state-specific ?base-benchmark plan? selection process that must also include the Affordable Care Act?s (ACA?s) ten statutory benefit categories (See Figures 1 & 2). The Rule also lists the proposed EHB benchmark plans for the 50 states and the District of Columbia (DC).
States were encouraged to submit their EHB benchmark selection by October 1st to set the benchmark for 2014 and 2015.2 Appendix A of the EHB Rule lists each state?s benchmark plan selection or default (for states that did not select a plan). For each state, HHS has posted (1) a summary of ?the specific benefits and limits, and prescription drug categories and classes? covered by the EHB benchmark plan, and (2) a list of state-required benefits.
HHS is requesting public comment on states? proposed EHB benchmark plans and the policies and standards in the EHB Rule.3 The proposed rule has a short 30-day comment period with comments due on December 26th. If a state wishes to make an EHB benchmark selection or change its previous selection it must do so by the end of this comment period.4 This EHB Step Guide is designed to help state advocates analyze the benchmark plan selected by their state, and includes some important considerations when reviewing benefits offered by EHB benchmark plans.

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