Essential Health Benefits: Balancing State Flexibility with Consumer Protections

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Last week, the U.S. Department of Health and Human Services (HHS) outlined its intended approach to defining the essential health benefit package—or minimum coverage standards—that will apply to health plans sold through the new state health insurance exchanges, as well as in the individual and small-group markets. In a <a href="/blog/2011/essential-health-benefits-balancing-state-flexibility-consumer-protections">new blog post</a>, Sara Collins, Ph.D., vice president for Affordable Health Insurance at The Commonwealth Fund, says HHS aims to offer states flexibility by allowing them to select an existing plan in their state as the "benchmark" coverage option rather than defining one standard package for all states. <br /><br />
The law stipulates that essential benefits must cover services within 10 categories, such as ambulatory patient services, emergency services, and maternity and newborn care. According to Collins, these requirements represent a dramatic change from the individual market of today, where health plans often do not cover a comprehensive set of services. In addition, they provide new transparency about benefits for consumers who must purchase coverage on their own. Ideally, people choosing among plans will no longer have to worry about benefit variation across plans, but will be able to focus on how plans differ in terms of out-of-pocket costs and premiums. <br />
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"It will be critical that HHS balances the desire of states and health insurers to determine what benefits are included with the law's intended goal of providing consumers and employers in every state with comprehensive and clearly defined health insurance coverage options," Collins says. <br />
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