Final Rule on Information Insurers Must Provide on Essential Health Benefits Released

The Obama Administration has released the rule outlining what information insurers must provide to the government pursuant to the Affordable Care Act. These data will help establish the Essential Health Benefits that all qualified health plans must offer to be admitted into the Health Insurance Exchanges that are scheduled to come online in 2014. Individuals, as well as businesses with up to 50 employees, will be eligible to enroll in these exchanges to purchase health insurance. The final rule is available here.

Pursuant to the rule, the federal government will collect data from the three largest health plans within each state’s small group market. It will then use those data to create the standards of coverage and care, called Essential Health Benefits, which must be offered for participation in the Health Insurance Exchanges. These benefits include ambulatory patient services, emergency services, maternity and newborn care, mental health and substance abuse, prescription drugs, rehab services, laboratory services, preventative and wellness care, and pediatrics.

The rule was controversial on both sides of the debate. Insurers are unhappy with the requirement that they outline the services they cover in addition to how they plan to limit access to those services. Consumer advocates, on the other hand, argued that they did not go far enough and that the government should also collect data on exclusions and cost-sharing.  

MSEC will continue to provide updates on new Affordable Care Act regulations as they become final.