Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a final rule that will make purchasing health coverage easier for consumers.  

The policies outlined will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act.  

“The Affordable Care Act helps people get the health insurance they need,” said Secretary Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”

The new rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace.

Through its standards for essential health benefits, the final rule also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.  

A new report by HHS details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans.

In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services.  

The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:

• By including mental health and substance use disorder benefits as Essential Health Benefits;
• By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets;
• By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services.

To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach.

This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan.  

Twenty-six states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest.

The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage.  

Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan.

Metal levels will allow consumers to compare insurance plans with similar levels of coverage and cost-sharing based on premiums, provider networks, and other factors.  

In addition, the health care law limits the annual amount of cost sharing that individuals will pay across all health plans – preventing insured Americans from facing catastrophic costs associated with an illness or injury.

Policies in the new rule also provide more information on accreditation standards for qualified health plans (QHPs) that will be offered through the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.

Together, these provisions will help consumers compare and select health plans in the individual and small group markets based on what is important to them and their families.

People can make these choices knowing these health plans will cover a core set of critical benefits and can more easily compare the level of coverage based on a uniform standard. Further, these provisions help expand choices and competition on the Marketplaces.

For more information on the rule visit: http://cciio.cms.gov/resources/factsheets/ehb-2-20-2013.html .

To view the rule, visit http://www.ofr.gov/inspection.aspx .

For more information on how the rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm .

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Written by: Editor

Published: 24 February 2013