Department of Health and Human Services (HHS) Secretary Kathleen
Sebelius today announced a final rule that will make purchasing health
coverage easier for consumers. The policies outlined today 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.”
Today’s 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 released today also expands coverage of mental
health and substance use disorder services, including behavioral health
treatment, for millions of Americans.
A new report by HHS, also released today, 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:
(1) By including mental health and substance use disorder benefits as Essential Health Benefits
(2) By applying federal parity protections to mental health and
substance use disorder benefits in the individual and small group
markets
(3) 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 today’s 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.
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