Group Makes Recommendations for Essential Health Benefits

August 24, 2012 ( - The Essential Health Benefits Coalition (EHBC) made recommendations to the Department of Health and Human Services (HHS) for the new health reform law's essential health benefits package.

By PLANSPONSOR staff | August 24, 2012
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According to the Coalition, providing flexibility in selecting a benchmark plan will help assure that states can tailor benefits to meet their residents’ health needs. Of equal importance is the need to ensure availability of high-quality, affordable coverage options. Making certain that EHB packages do not put the cost of coverage beyond the reach of small businesses, their employees and individuals must be a central objective, the EHBC contended.   

The Coalition offered the following considerations:  

  • Adopt Institute of Medicine (IOM) Premium Target Recommendation. In its report to HHS, the IOM recommended setting a premium target that reflects the current average cost of a small-business health insurance plan as the benchmark for determining the inclusion of specific benefits in the EHB package. The Coalition strongly agrees with the IOM that currently available small group coverage should guide the EHB package.
  • Avoid including benefits not typically offered under small group plans. Benefits included in the benchmark should include only those typically offered under small group plans. To help ensure coverage affordability, expanding these benefits beyond the minimum necessary to comply with the law should be avoided. 
  • Allow Private Sector Strategies to Achieve Greater Benefit Value and Affordability; Avoid Applying Medicare Requirements. Private sector benefit design, medical management and care delivery approaches have helped achieve greater benefit value and affordability. The Coalition strongly urges HHS to ensure that health plans can continue to use these strategies employed in the commercial market and not to apply Medicare requirements, which would limit plans’ ability to craft and implement innovative strategies to improve quality, outcomes and value.