Essential health benefits: Review of the state employee benchmark plans and illustration of possible variation in essential health benefits by state

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By Robert G. Cosway | 03 December 2012

The Patient Protection and Affordable Care Act of 2010 (PPACA) introduced a concept called essential health benefits (EHB), ten categories of healthcare services that plans operating in the state health insurance exchanges must cover when the exchanges come online on January 1, 2014. In December 2011, the U.S. Department of Health and Human Services (HHS) issued a bulletin providing guidance on EHB.

HHS delegated to the states the responsibility for determining the essential benefits in their states, with some constraints. This initial approach by HHS (for plan years 2014 and 2015) is intended to help states phase in the market reforms. It allows some flexibility for states in the initial decision about which specific services will be covered as essential, but limits the choice to what is currently covered by major plans in the state and nationally. States must define their essential benefits during the third quarter of 2012, with varying progress to date. This paper reviews the state employee benchmark plans and illustrates possible variation in essential health benefits by state.

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