HPIO policy brief explores Ohio options for determining 'essential health benefits'

The Health Policy Institute of Ohio has released a new publication titled: "An introduction to 'essential health benefits': Ohio’s role in determining services covered by insurance post-2014" (pdf, 6 pages).

The policy brief summarizes Ohio's options for determining a benchmark set of essential health benefits, or EHB, for small group and individual health insurance plans sold in the state after the Patient Protection and Affordable Care Act, or ACA, is fully implemented on Jan. 1, 2014.

The ACA requires that most small group and individual health insurance plans offer a comprehensive package of covered items and services. This provision pertains to plans offered both inside and outside a federal or state insurance exchange. The intent of the EHB provision is to assure consumers and small businesses that when they purchase a health plan, they can be certain that it will cover a comprehensive set of health services.

In December 2011, the Department of Health and Human Services (HHS) issued a Bulletin signaling its intent to allow states to determine individually the benchmark set of EHB for plans sold in their state, with states required to make a decision by the third quarter of 2012. If Ohio policymakers do not take the opportunity to identify Ohio’s benchmark for EHB, the default benchmark will be the largest small-group plan offered in the state.

"In considering what this means for Ohioans purchasing coverage in the small group and individual markets, Ohio’s policymakers and other stakeholders must balance the desire for consistency and comprehensiveness of benefits with potential increased cost in covering these benefits," the policy brief concludes.