Essential Health Benefits
On December 16, 2011, DHH issued a bulletin outlining proposed policies that will give states more flexibility and freedom to implement the Affordable Care Act.
Essential health benefits must include items and services within at least the following 10 categories:
Under the department’s intended approach announced today, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan that would best meet the needs of their citizens.
It is important to note that the Affordable Care Act distinguishes between a health plan’s covered services, and the plan’s cost-
bronze at 60% actuarial value,
silver at 70% actuarial value,
gold at 80% actuarial value, and
platinum at 90% actuarial value.
Qualified Health Plan
Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by an Exchange, provides essential health benefits, follows established limits on cost-
Source: Healthcare.gov By William F. Schaake, CIC, CRM © 2012