You are here:HomeIssuesHealth Care Reform2013HHS Issues Essential Health Benefits Standards

HHS Issues Essential Health Benefits Standards

The Obama administration last week issued its long-awaited final rule on what states and insurers must do to provide the essential health benefits required in the individual and small-group market beginning in 2014 under the healthcare reform law...
February 27, 2013

The Obama administration last week issued its long-awaited final rule on what states and insurers must do to provide the essential health benefits required in the individual and small-group market beginning in 2014 under the healthcare reform law.

Obama’s Patient Protection and 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, prescription drugs and maternity and newborn care.

The final rule preserved the state role in determining how the requirements are met, by selecting their own benchmarks from plans sold within their respective borders. Most states opted for their home market’s largest small-group plan. But after two years, HHS said it would review the situation and determine whether a new approach might be necessary.

HHS officials found that maintaining states as primary regulators of state insurance markets would keep benefit offerings more in line with services typically offered through employer-sponsored plans in each state.

What It Means to Agents: These standards do not have a direct bearing on the issues that PIA is focusing on – ensuring that independent agents will continue to be able to sell policies, whether or not they are offered through an exchange. PIA is also working to ensure that agents are fairly compensated, and not supplanted by unlicensed and untrained “navigators” performing the functions of agents.

The best news for agents in this is that HHS is implementing the Affordable Care Act (ACA) as a state-based program, with deference to state regulations and standards, apparently even in states that have defaulted the operation of insurance exchanges back to the federal government.

Filed under: