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HHS Provides Guidance on Essential Health Benefits Package - December 16, 2011

Today HHS released an informational bulletin outlining how it intends to define "essential health benefits" for purposes of the Affordable Care Act. The definition is important as beginning in 2014 all health plans offered in the individual and small-group market must cover the essential health benefits package. The bulletin announces that HHS will allow each State to define its own "essential health benefits package" based on a "benchmark" chosen by the State. 


A State may choose from one of the following 4 benchmarks:

  • One of the three largest small group plans in the state by enrollment;
  • One of the three largest state employee health plans by enrollment; 
  • One of the three largest federal employee health plan options by enrollment;
  • The largest HMO plan offered in the state's commercial market by enrollment.  


The benefits and services included in the benchmark chosen by the State will be the State's "essential health benefits package." States with benefit mandates that exceed essential health benefits will be responsible for defraying the costs associated with these mandates. The HHS bulletin is not a rule and HHS will still need to proceed with the rule-making process at some time in the future.