The Department of Health and Human Services (HHS) provided illustrative information to complement its Dec. 16, 2011, bulletin on essential health benefits (EHB) under the Patient Protection and Affordable Care Act. The information provides the names of the three largest products in the small group market in each state ranked by enrollment, as well as a list of the top three nationally available Federal Employee Health Benefit Program plans based on enrollment.
In an earlier bulletin released Dec. 16, 2011, HHS described the approach it intends to pursue in rulemaking to define these essential health benefits. Under that approach, states would be able to select an existing health plan to set as a benchmark for the items and services included in the package. The options would be:
- one of the three largest small group plans in the state;
- one of the three largest state employee health plans;
- one of the three largest federal employee health plan options;
- the largest HMO plan offered in the state’s commercial market.
Plans could modify coverage as long as they do not reduce the value of coverage. States must also ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services and prescription drugs.
For additional information:
Fact sheet
ASPE Issue Brief – summary of individual market coverage
ASPE Research Brief – information on comparing benefits in small group products and state and federal employee plan
