December 12, 2012

DIFP invites comments related to essential health benefits

Dec. 19 deadline for comments on benchmark plan

The U.S. Department of Health and Human Services (HHS) published a proposed rule in the Federal Register on Nov. 26, 2012 outlining health insurance issuer standards related to the coverage of essential health benefits (EHB). All non-grandfathered plans in the individual and small group markets will be required to provide coverage for essential health benefits for plan years beginning on or after Jan. 1, 2014.

In guidance issued in December 2011, as well as the proposed rule, HHS outlined several options from which states can select an EHB benchmark plan. The EHB Benchmark plan establishes the floor of coverage for plans in the individual and small group markets beginning January 1, 2014. HHS guidance and the proposed rule also identify a default base-benchmark plan, which is the largest plan by enrollment in the largest product in the state's small group market. This plan will be the EHB benchmark plan for states that do not make a selection. Missouri did not identify a base-benchmark plan and accordingly the default plan, Healthy Alliance Life Insurance Company (Anthem BCBS) Blue 5 Blue Access PPO Medical Option 4 Rx Option D, is designated as the proposed EHB Benchmark for Missouri in the proposed federal rule.

In anticipation of the proposed rule published in November, the Department engaged the actuarial firm Oliver Wyman to complete a technical comparison of the plans that could be selected as the base benchmark plan. See the Oliver Wyman analysis here

The rule promulgated by HHS is open for public comment for a 30-day period, which ends on December 26, 2012. We invite public comments related to the proposed EHB Benchmark Plan. These comments will serve to provide additional information to the Department as we decide whether to make comments on the proposed rule. Due to the short public comment period, we ask that any comments to the Department be made via email no later than Dec. 19, 2012.