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The Coalition—composed of groups representing employers, pharmacy benefit managers and health plans across America—has previously cautioned that an expansive essential health benefits package would force employers to absorb higher health care costs at the expense of creating new jobs and increasing wages; pass more costs onto their workers; or stop offering health coverage altogether. For employers who do not currently offer coverage, an expansive essential benefits package would put affordable coverage further out of reach. The Coalition maintains there are four essential criteria that HHS’ final essential benefits package must satisfy: The essential health benefits package must be affordable. It should provide basic services that Americans need to protect their health, not expansive coverage that is unaffordable for individuals or small employers. The package must be flexible. It should give individuals and employers the choice to purchase a range of plans and options, and it must allow for flexibility in insurance design and cost-sharing arrangements. The package should make it easier for employers to offer, and individuals to obtain coverage. The economy needs businesses to grow and hire more workers—a benefits package that is too expensive will hinder business and job growth. The package must consider all costs associated with its development. Taxpayer costs will greatly increase if more employers are priced out of offering coverage, further threatening America’s fiscal future. Generally, non-grandfathered insured plans in the small group market, as well as plans offered through an Exchange, will be required to offer essential health benefits beginning in 2014 (see “SECOND OPINIONS: Which Health Plan Benefits Are ‘Essential’ under PPACA?”). In addition, all group health plans (both insured and self-funded) are prohibited from imposing lifetime or annual dollar limits on essential health benefits.
The Coalition—composed of groups representing employers, pharmacy benefit managers and health plans across America—has previously cautioned that an expansive essential health benefits package would force employers to absorb higher health care costs at the expense of creating new jobs and increasing wages; pass more costs onto their workers; or stop offering health coverage altogether. For employers who do not currently offer coverage, an expansive essential benefits package would put affordable coverage further out of reach.
The Coalition maintains there are four essential criteria that HHS’ final essential benefits package must satisfy:
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