On February 20, 2013, the U.S. Department of Health and Human Services(HHS) released the final regulations regarding essential health benefits (EHB).
These guidelines will be used to define the benefits that must be included with all fully insured health plans sold inside and outside of the exchanges in 2014.
These guidelines affect all individual health insurance plans as well as group plans.
Grandfathered plans and self-insured plans are not required to meet these essential health benefits but are required to provide coverage without any annual or lifetime dollar limits.
Open enrollment for health insurance plans on the exchange begins October 1, 2013 with plan effective dates of January 1, 2014.
These plans are also expected to be available on the private or individual market through licensed brokers.
We now know that these fully insured plans no matter which marketplace will contain the following benefits without annual or lifetime limits:
* Ambulatory patient services
* Emergency services
* Hospitalizations
*Maternity and newborn care
*Mental health and substance use disorder services including behavioral health treatment
*Prescription drugs
*Rehabilitative services and devices
*Laboratory services
*Preventive and wellness services and chronic disease management
*Pediatric services, including dental and vision care.
The State of Illinois has released details for their own EHB benchmark plan.
Healthcare reform legislation requires that each state meet or exceed the federal benchmark plan benefits.
You can find more information by contacting your health insurance broker or visit the Essential Benefits Fact Sheet.
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