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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Selected Medical Benefits: A Report

This April 2011 report from the Labor Department tabulates information from the BLS National Compensation Survey to help HHS determine what constituted an “essential benefit,” and examines data for 12 additional services for which HHS requested information on coverage and cost sharing. The study mainly looked at large employer benefits. (more…)

Frequently Asked Questions on Essential Health Benefits Bulletin

CMS Document from February 17, 2012

State Employee Benefit Choice Options

This handbook describes the health benefits available to all Illinois state employees. This is important because HHS guidance on ACA essential health benefits says that each state will determine its own EHB package, potentially based on its largest state employee plan. (more…)

The Need for Strong Federal Essential Health Benefits Standards

This August 2012 letter from 80 organizations to HHS Secretary Kathleen Sebelius notes that the agency has received numerous received numerous comments urging the use of a non-prescriptive EHB standard to keep the costs of health plans lower, but urges a robust, clear and prescriptive Federal EHB policy.

Top Three Small-Group Products by State

This December 2011 CMS document provides illustrative information to complement the bulletin on ACA essential health benefits released on December 16, 2011. It lists the products with the three largest enrollments in the small group market in each state. It also includes the top three nationally available Federal Employee Health Benefit Program plans based on enrollment.

5 Key ACA Standards that Will Impact Family Planning

This May 2011 document from the National Health Law Program, or NHeLP, explains these Affordable Care Act terms – Qualified Health Plans, Essential Health Benefits, Benchmark Plans, Preventive Care, and Essential Community Providers. A grasp of the complex ways these new standards interact with each other is key to understanding how access to family planning services will be impacted in Medicaid and the insurance exchanges.

Essential Health Benefits and People with Disabilities

This issue brief from the Commonwealth Fund examines how the ACA’s “essential health benefits” provision will help Americans with disabilities, who currently are subject to discrimination by insurers based on health status and health care need. (more…)

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