HHS Releases Proposed Standards Related To Essential Health Benefits

Beginning January 1, 2014 the healthcare reform bill will require health insurance companies to maintain a single, statewide pool for all of their individual health plans.  They may actually combine their small employer market group with the individual health plan into a single statewide pool.  This ensures that insurance premium rate increases would be based on the entire risk pool.  This prevents insurance companies from carving up a state to place higher risk people in single groups to achieve higher premiums.  This proposed rule also includes provisions for health insurance companies to develop catastrophic health insurance plans for the individual market for young adults and people who qualify for the catastrophic health insurance plan.

It also provides a list of the 10 categories that must be included in the core package of essential services.  It identifies the four health insurance plan types which are: the bronze plan which covers 60% of the cost, a silver plan that covers 70% of the cost, a gold plan that covers 80% of the cost and a platinum plan that covers 90% of the cost.  It also establishes the maximum out of pocket cost and in network versus out of network coverage.

The full proposed rule can be viewed using the following link:

http://www.gpo.gov/fdsys/pkg/FR-2012-11-26/pdf/2012-28362.pdf