After releasing a number of bulletins and a proposed regulation, the the U.S. Department of Health and Human Services has issued its final rule on what constitutes “essential health benefits” under the healthcare reform law.
Starting on Jan. 1, 2014, all non-grandfathered health insurance plans in the individual and small group markets – whether offered through a state exchange or not – will be required to cover services in 10 specific categories, which are meant to reflect the benefits covered by a “typical” employer health plan.
The final rule also sets up a timeline for when qualified health plans should be accredited in federal exchanges. In order for a plan to be a qualified one, it must cover essential health benefits, include cost-sharing limits and meet the reform law’s minimum value requirements.
The HHS also created an actuarial value calculator that employers can use to determine their plan’s coverage level. The reform law creates four tiers of health plans for purchase on the exchanges (bronze, silver, gold and platinum) based on percentage of total allowed costs of benefits.
Go here for a PDF of the final rule.