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Essential Health Benefits

The Affordable Care Act (ACA) includes a proposed rule to establish health insurance exchanges at the state level. As stated in the proposed rule July 15 2011, insurance exchanges are “to provide competitive marketplaces for individuals and small employers to “directly compare available private health insurance options on the basis of price, quality, and other factors.” The Exchanges are slated to become operational by January 1, 2014 and will “help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.”

The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, offer a comprehensive package of items and services, known as essential health benefits, among them preventive services. Click here for a definition and more information.

Consistent with the law, states must ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs. However, in a December 12 201 HHS press release, the Secretary announced that to ensure state-level flexibility, states the flexibility to design coverage options that meet their unique needs and may select certain plans within their state as the “benchmark. Click here for more information.

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