The Department of Health and Human Services (HHS) released a pre-rule bulletin in December to outline their intended regulatory approach to defining Essential Health Benefits. As a follow-up, HHS recently released an FAQ document to provide additional guidance on the approach. Specifically, the FAQ document provides clarification regarding which groups of health plans do and do not have to offer essential health benefits in 2014.
Groups who DO have to cover essential health benefits in 2014
- Plans on the exchange
- Non-grandfathered individual health care plans
- Non-grandfathered, fully insured small group health plans
Groups who DO NOT have to cover essential health benefits in 2014
- Self-insured health plans (including health reimbursement arrangements)
- Grandfathered health plans
- Non-grandfathered, fully insured large group health plans
According to the FAQ, these plans are permitted to impose non-dollar limits, consistent with other guidance, on essential health benefits as long as they comply with other applicable statutory provisions. In addition, these plans can continue to impose annual and lifetime dollar limits on benefits that do not fall within the definition of essential health benefits.