New HHS Bulletin Confirms Exemption from the Requirement to Provide Essential Health Benefits for Many Employer-Sponsored Health Plans
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New HHS Bulletin Confirms Exemption from the Requirement to Provide Essential Health Benefits for Many Employer-Sponsored Health Plans The Center for Consumer Information and Insurance Oversight ("CCIIO"), a division of the Department of Health and Human Services ("HHS"), recently issued an Essential Health Benefits Bulletin to provide information and solicit comments on the regulatory approach that HHS plans to propose to define essential health benefits under Section 1302 of the Affordable Care Act. Beginning in 2014, certain health plans must cover these essential health benefits. The bulletin is available at: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf. This bulletin provides CCIIO’s proposal that essential health benefits be defined by a benchmark plan selected by each state. This benchmark plan will reflect both the scope of services and any limits offered by a typical employer-sponsored plan in that state. Regardless of the state’s selected benchmark plan, health plans that are required to offer essential health benefits must provide benefits in each of the ten categories of essential health benefits set forth in the Affordable Care Act. Clearly, it would be very difficult for employers with health plans covering employees in multiple states to comply with a rule that required different standards for essential health benefits in each state. Fortunately, a footnote within the bulletin confirms that most such employer-sponsored plans will not have to provide essential health benefits. This exemption confirms previous informal guidance that had suggested the requirement to provide essential health benefits would be primarily focused on individual policies offered on a state exchange. Footnote 1 in the bulletin states that the following types of health plans are not required to cover the essential health benefits: We expect future HHS proposed regulations on this topic to further describe these exemptions for those health plans that are not required to comply with the Affordable Care Act’s requirement to provide essential health benefits. —BRIAN C. GILMORE
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