HHS Finalizes Rule Outlining EHB And Minimum Value Standards

The Department of Health and Human Services (HHS) has issued final regulations that outline health insurance issuer standards for essential health benefits (EHBs) as applicable to non-grandfathered health insurance coverage in the individual or small group markets. In addition, the final rule provides guidance on the calculation of minimum value (MV) for employer-sponsored group health plans. The final rule is scheduled to be published in the February 25 Federal Register.

The regulations give an internet address for a new MV Calculator, designed to test whether an employer-sponsored group health plan (not in the individual or small group insurance markets) provides minimum value and whether or not an employee is eligible for a premium tax credit. It can be found at http://cciio.cms.gov/resources/regulations/index.html#pm. It is similar in design to the previously-issued Actuarial Value (AV) Calculator, which was reflective of the individual and small group markets, but it is based on data more representative of typical employer-sponsored plans.

The final rule also expands coverage of mental health and substance abuse disorder services, including behavioral health treatment, by including mental health and substance abuse disorder benefits as EHBs, by applying federal parity protections to those benefits in the individual and small group markets, and by providing expanded access to care that includes coverage for those benefits.

In the regulations, the HHS has finalized a benchmark-based approach to EHB, which allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan. It outlines (AV) levels or “metal levels,” representing percentages of costs in the individual and small group markets. A bronze health plan has an AV of 60 percent, a silver plan has an AV of 70 percent, a gold plan has an AV of 80 percent, and a platinum plan has an AV of 90 percent.

The final rule also limits the annual amount of cost sharing that individuals will pay across all health plans and provides details on accreditation standards for qualified health plans that will be offered through the new state health care exchanges.

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