Just before the most recent California Health Benefit Exchange board meeting, the federal Health and Human Services agency released its list of proposed essential health benefits. Aimed at ensuring that health plans in individual and small group markets offer a minimum of coverage — both inside and outside of health benefit exchanges — the HHS proposed list is scheduled to take effect in 2014.
Board members got a quick briefing on the proposed requirements, since comments on them are due at the end of January. That leaves the board with one more meeting — on Jan. 17 — to approve comments on those benefit requirements, according to Peter Lee, executive director of the board.
“It’s something we didn’t expect to see,” Lee said. “We didn’t know it was coming.”
There are 10 categories of benefits under the proposal, “so it’s not weighted in any particular area,” according to Katie Marcellus of the board staff, who presented the overview to the board.
“There are a few coverage issues to note,” Marcellus said. “For instance, if a plan doesnât cover all 10 categories, the state has to supplement it.”
Board member Kim BelshÃ© said on her first reading of the proposal that it seems to leave a lot of critical decisions to the states.
“It effectively transfers those tricky questions about balance of mandate versus affordability to us,” BelshÃ© said.
The 10 categories of essential health benefits are:
- Ambulatory care;
- Emergency services;
- Maternity and newborn care;
- Mental, behavioral substance abuse services;
- Prescription drugs;
- Rehabilitative services and devices;
- Laboratory services;
- Preventive services and chronic disease management; and
- Pediatric services (including oral and vision care).