Administration Sets New Rule On Essential Health Benefits

The Obama administration has released the final rule on essential health benefits, which sets the parameters for the types of benefits that must be offered by insurers starting in 2014. KHN is tracking the news coverage.

Kaiser Health News: Capsules: Essential Health Benefit Rule Made Final
Essential benefit requirements apply to individual and small group plans sold within and outside the new online, state-based exchanges scheduled to launch in 2014. The requirements also apply to benefits provided to those newly eligible for Medicaid coverage. These requirements do not apply to self-insured health plans, which is how most large companies cover their employees (Appleby, 2/20).

NBC News: Final Health Benefit Rules Carify Some Confusion
The Obama administration cleared up some confusion on Wednesday about rules governing just which health services insurance companies have to pay for. For instance, if you get a colonoscopy and the doctor finds a pre-cancerous growth and removes it, that still counts as a cancer screening and you won’t have to pay anything for it (Fox, 2/20).

The Hill: New Healthcare Rule Expands Benefits For Substance Abuse, Mental Disorders
The Obama administration on Wednesday finalized a key Affordable Care Act rule predicted to expand substance abuse and mental disorder benefits to 62 million Americans. The rule, to take effect next year, lays out new "essential health benefits" standards for insurers, as required by the landmark legislation. It was designed to allow consumers a simplified and consistent way to shop for, and enroll in, healthcare plans that best suit them (Goad, 2/20).

USA Today: HHS Releases Rule On Insurers' Essential Health Benefits
The rule defines what must be covered in exchange plans, prohibits discrimination based on age or pre-existing conditions, describes prescription drug benefits and determines levels of coverage. ... But the rule doesn't include any surprises: A proposed rule released in November looks much the same as today's version (Kennedy, 2/20).

Reuters: Published in the Federal Register by the U.S. Department of Health and Human Services, the rule emerged as private insurers worked to devise health plans that could be sold in new online state marketplaces, known as healthcare exchanges, which are scheduled to begin enrolling beneficiaries on Oct. 1 (2/20).

Politico Pro: EHB Rule Shows Efforts At State Flexibility
Final rules on mandated benefits and new cost-sharing limits show continued efforts by the Obama administration to provide leeway to states and insurers through at least the first two years of implementation of the health law. The much-anticipated rules, released Wednesday, don’t include major shifts from past policy indications from the administration (Millman, 2/20).

The HHS rule can be found here.