HHS releases essential health benefits final rule


The U.S. Department of Health & Human Services released a final rule outlining the specific essential health benefits that insurers must cover regardless of whether they're selling plans through health insurance exchanges.

Perhaps the biggest change in the rule, which was released Wednesday, is that it requires insurers to expand their coverage of mental health and substance abuse services, including behavioral health treatment, HHS said in a statement.

By requiring insurers to offer a core package of standardized benefits in the individual and small business markets, the rule promotes consistency and ensures consumers receive benefits "equal in scope" to those offered within a typical employer-based plan, according to an HHS fact sheet.

The standard essential health benefits that health plans must provide 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.

HHS reiterated its initial plan to grant states the authority to determine their own essential health benefits. That means states can choose a benchmark plan based on existing options in their own markets that all insurers must also provide. Already, 26 states have selected a benchmark plan; the remaining states' benchmark plans will be the largest small business plan, HHS said.

To learn more:
- here's the final rule (.pdf)
- read the HHS statement and fact sheet

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