Essential health benefits
Beginning in 2014, the Affordable Care Act requires that all small group and individual insurance plans provide a minimum level of benefits known as “essential health benefits.” This requirement applies to plans sold through the health insurance exchange and plans sold outside the health insurance exchange. It does not apply to large, employer-sponsored plans. Section 1302 of the Affordable Care Act defines 10 broad categories of services that make up the essential health benefits. These categories are 1.) ambulatory patient services, 2.) emergency services, 3.) hospitalization, 4.) maternity and newborn care, 5.) mental health and substance use disorder services (including behavioral health treatment), 6.) prescription drugs, 7.) rehabilitative and habilitative services and devices, 8.) laboratory services, 9.) preventive and wellness services and chronic disease management, and 10.) pediatric services, including oral and vision care.
Under the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) became responsible for determining what specific services within those broad categories would be included in the essential health benefits package. In December 2011, HHS announced that it would let states select the services in their essential benefits package, based on benefits in existing plans offered in each state.
Arkansas’s implementation
Arkansas has established a Plan Management Advisory Committee to help define the essential health benefits for the state. On May 18, 2012, the group selected the Blue Cross Blue Shield PPO as the benchmark plan it recommended to the benefits exchange Steering Committee. On May 25, the Steering Committee voted, instead, to recommend any of the state's three small group plans as the essential health benefits benchmark. The issue is currently before the Arkansas Insurance Commissioner for a final decision.
Federal Documents
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Essential Health Benefits Bulletin
PDF
This document describes the approach that HHS will use to define the essential health benefits.
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News Release: HHS to give states more flexibility to implement health reform
Arkansas Documents
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ACHI Issue Brief: Tobacco Cessation Services--An Essential Health Benefit?
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AR Insurance Commissioner's Benchmark Health Plan Selection
PDF
This directive, issued by the Arkansas Insurance Department, announces the Insurance Commissioner's selection of a benchmark health plan. This benchmark plan will serve as the standard for providing the essential health benefits, which most plans will be required to offer.
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Arkansas's Health Insurance Mandates
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Comparison of Benefits in Existing Arkansas Plans
Excel
This document outlines the benefits in the existing plans in Arkansas. The state must choose one of these plans as the basis for its essential health benefits package.
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Detailed Comparison of Arkansas's Small Group Coverage and Medicaid
PDF
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EHB Issue Brief for Arkansas
Word
This document, written by consultants hired by the Insurance Department, provides information about the essential health benefits requirements under the Affordable Care Act and how they apply to Arkansas.
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Essential Health Benefits Rules
PDF
These rules provide guidance for the Arkansas Insurance Commissioner for the selection of the state's essential health benefits benchmark plan. The Arkansas Legislative Council's Rules and Regulations Subcommittee approved the rules in August 2012.