Essential Health Benefits Reform

As health care reform begins going into effect, many states are initiating their discussion of future plans for health exchanges.  According to the new reform provisions, small group and individual health plans both participating and not participating in the exchange must offer essential health benefits beginning January 2014.  The Health and Human Services department recommends that states choose a specific coverage plan as a benchmark for providing essential health benefits.  States have the option to choose from one of the four plans provided by HHS to use as their benchmark, however, if states choose not to use a benchmark, the default will be the small group plan with the largest enrollment in the state.  To see these four plans, go to Cigna’s article on Essential Health Benefits.
According to Cigna, certain states may label small groups differently.  Currently, small groups are defined as up to 50 employees, however some states may raise this limit to 100 employees.  By January 2016 the national definition of small groups will be 1-100 employees.
Essential health benefits is established under the Patient Protection Affordable Care Act.  Essential health benefits will include emergency services, ambulatory and patient, services, and pediatric services.  For a complete list of the services provided under Essential Health Benefits, click here.

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