HHS proposed three new rules today related to the Patient Protection and Affordable Care Act, and the rules involved several major portions of the law, including essential health benefits, health insurance market reforms and employer-sponsored wellness programs.
The proposed rule on essential health benefits says that health plans offered in the individual and small group markets must include items and services in 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, lab services, chronic disease management, and pediatric services, including oral and vision care.
The rule also mandated that EHB be "equal in scope to benefits offered by a typical employer plan," and states will meet this requirement based on state-specific benchmark plans. Benchmark plans have several options; for example, a benchmark plan can be the basic plan in the largest insured commercial HMO in the state.
Within the EHB proposed rule, HHS officials also defined "actuarial value." AV is the percentage of total average costs for covered benefits that a plan will cover. There are four main plans: bronze, silver, gold and platinum. A platinum plan has an AV of 90 percent, meaning on average, a consumer is responsible for 10 percent of the costs of all covered benefits. The AVs slide down 10 percent from there, meaning bronze has an AV of 60.
The proposed rule on health insurance market reforms hones in on many of the prominent features touted in President Obama's healthcare law. For example, the proposed rule mandated that health insurers in the individual and small group markets cannot discriminate against individuals because of a pre-existing or chronic condition, starting in 2014 when health insurance exchanges go live.
Health insurers must also abide by "fair health insurance premiums." For example, if insurers want to charge higher premiums based on age, tobacco use, family size and geography, they must adhere to certain ratios and limits.
HHS, the Department of Labor, and the Treasury also jointly released a proposed rule on implementing and expanding employer wellness programs to "not only improve the health of Americans, but also help control healthcare spending." It builds on previous provisions from the PPACA for employers to design "consumer-protective wellness programs" in group health plans, effective in 2014. For example, the government will support workplace wellness programs that reimburse the cost of membership in a fitness center, that provide a reward to employees for attending a free monthly health education seminar and others.
The proposed rule on essential health benefits says that health plans offered in the individual and small group markets must include items and services in 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, lab services, chronic disease management, and pediatric services, including oral and vision care.
The rule also mandated that EHB be "equal in scope to benefits offered by a typical employer plan," and states will meet this requirement based on state-specific benchmark plans. Benchmark plans have several options; for example, a benchmark plan can be the basic plan in the largest insured commercial HMO in the state.
Within the EHB proposed rule, HHS officials also defined "actuarial value." AV is the percentage of total average costs for covered benefits that a plan will cover. There are four main plans: bronze, silver, gold and platinum. A platinum plan has an AV of 90 percent, meaning on average, a consumer is responsible for 10 percent of the costs of all covered benefits. The AVs slide down 10 percent from there, meaning bronze has an AV of 60.
The proposed rule on health insurance market reforms hones in on many of the prominent features touted in President Obama's healthcare law. For example, the proposed rule mandated that health insurers in the individual and small group markets cannot discriminate against individuals because of a pre-existing or chronic condition, starting in 2014 when health insurance exchanges go live.
Health insurers must also abide by "fair health insurance premiums." For example, if insurers want to charge higher premiums based on age, tobacco use, family size and geography, they must adhere to certain ratios and limits.
HHS, the Department of Labor, and the Treasury also jointly released a proposed rule on implementing and expanding employer wellness programs to "not only improve the health of Americans, but also help control healthcare spending." It builds on previous provisions from the PPACA for employers to design "consumer-protective wellness programs" in group health plans, effective in 2014. For example, the government will support workplace wellness programs that reimburse the cost of membership in a fitness center, that provide a reward to employees for attending a free monthly health education seminar and others.
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