Your Source for Health Reform

Topic: Essential Health Benefits



The ACA requires health plans offered in the individual and small-group markets to cover 10 categories of essential health benefits needed to prevent and treat illness, including outpatient and emergency care, hospitalization and prescription drugs.


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Coverage is Good Medicine

This pocket card from Doctors America gives health care providers a script to discuss health insurance with their clients. The pocket card, updated for 2014-2015, answers common questions that patients may have about the benefits of health insurance.

Enrollment Issues for Small Businesses

This March 2014 information sheet and frequently asked questions from the Robert Woods Johnson Foundation addresses common concerns for small employers as they explore health insurance options for their workers.

Essential Health Benefits Benchmark for Illinois

After several meetings, the Essential Health Benefits Workgroup convened by the Governor’s office presented their final recommendation in September 2012 for Illinois’ Essential Health Benefits benchmark plan. This plan will be the reference point for all non-grandfathered individual and small group health plans sold inside and outside of the Illinois Health Insurance Exchange beginning in 2014.

Essential Health Benefits: Building a Better Benchmark

Slides from the Center on Budget and Policy Priorities’ webinar on the Essential Health Benefits benchmark plan and how each state is to create that benchmark plan.

State of Illinois Comparison of Benchmark Options

These are the plans that the state is using to choose as its benchmark small group plan. They are grouped into the 10 categories of Essential Health Benefits required by the ACA.

Illinois Essential Health Benefits FAQ

This FAQ from the Illinois Health Care Reform Implementation Council provides the Basic Facts and State Options for deciding the state’s Essential Health Benefits package. A decision needs to be made by September 30, 2012.

Letter to DOI: Essential Health Benefits

A letter by several groups involved with chronic conditions sent in May 2012 to the director of the Illinois Department of Insurance, asking that the department to make information available regarding to potential benchmark plans for Illinois’ Essential Health Benefits plan. The letter lists 31 health plan benefits that are important in treating heart disease, diabetes, cancer, multiple sclerosis, and stroke.

Essential Health Benefits Benchmark Options Evaluative Tool for Chronic Disease Patients

A tool designed by a group of Illinois Health Advocacy organizations (American Cancer Society, American Diabetes Association, American Heart Association, American Stroke Association, National Multiple Sclerosis Society).

Health & Disability Advocates’ Comments on Essential Health Benefits Bulletin

HDA comments to HHS on the essential health benefits bulletin released December 16, 2011, and the supplementary material released on January 25.

Essential Health Benefits: Balancing Coverage and Cost

Institute of Medicine: REPORT BRIEF OCTOBER 2011

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