Health insurance policies included in the state health insurance exchanges must include 10 essential core benefits, Health and Human Services (HHS) Secretary Kathleen Sebelius announced on Feb. 20. States must develop a benchmark plan equal in benefit coverage provided in a “typical employer plan” found in the state. States have flexibility in how they define a typical employer plan.
The health exchanges, linchpin of the Affordable Care Act (Obamacare) are scheduled to open enrollment this October, with coverage beginning January 2014. The final ruling issued this week expands coverage for mental health and substance use disorders. According to HHS, nearly 20 percent of individual health insurance policies currently do not cover these health issues. Access to mental health care has been brought to the forefront of the national conversation on how to reduce gun violence in the country.
The 10 essential core benefits that must be included in insurance plans are:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
The ruling also defines the percent of medical costs a policy must cover at each policy level. For ease of comparison when shopping for health insurance, policies in the insurance exchanges will be assigned to one of four “metal levels”: Bronze, silver, gold and platinum. The percent of medical costs that must be covered by insurers at each level are as follows:
- Bronze – 60 percent
- Silver – 70 percent
- Gold – 80 percent
- Platinum – 90 percent
Individuals and families seeking health insurance may select the coverage level that best fits their personal health needs and financial requirements.
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