On February 20, 2013, the Department of Health and Human Services (HHS) released a final rule on new non-grandfathered health plans’ Essential Health Benefits (EHBs), percentage of costs health plans are expected to cover (actuarial value) and accreditation guidelines for "qualified" health plans. The final rule largely follows from the proposed rule released in November of 2012.
The final rule implements Affordable Care Act (ACA) provisions that require health plans to cover specified categories of services or "essential health benefits." The required categories for essential health benefits include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services. The rule contains provisions that would allow states’ flexibility on essential health benefits.
The actuarial value provision of the rule requires health insurance plans to cover at least 60 percent of costs, and rates health plans on "metal levels" based on percentage of costs the plan will cover. M etal levels range from bronze to platinum.
Finally, the rule contains provisions related to accrediting qualified health plans.
Review the rule.
Review the Fact Sheet on the Final Rule.
Review the CMS Press Release.