2013-03-28 / Community

Health law rule to allow consumers to compare

WASHINGTON – A rule making the purchase of health coverage easier for consumers begins in 2014. The policies out into place by the rule enable consumers to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act.

“The Affordable Care Act helps people get the health insurance they need,” said Department of Health and Human Services Secretary Kathleen Sebelius. “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”

The rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for essential health benefits, the final rule released today also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.

A new report by HHS, also released, details how these provisions will expand mental health and substance use disorder benefits and federal parity protections for 62 million more Americans.

In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. The rule seeks to fix that gap in coverage by expanding coverage of these benefits in three distinct ways:

1) By including mental health and substance use disorder benefits as Essential Health Benefits

2) By applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets

3) By providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services

To give states the flexibility to define essential health benefits in a way that would best meet the needs of their residents, this rule also finalizes a benchmark-based approach. This approach allows states to select a benchmark plan from options offered in the market, which are equal in scope to a typical employer plan. Twentysix states selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest.

The rule additionally outlines actuarial value levels in the individual and small group markets, which helps to distinguish health plans offering different levels of coverage. Beginning in 2014, plans that cover essential health benefits must cover a certain percentage of costs, known as actuarial value or “metal levels.” These levels are 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan.

For more information visit: aspe.hhs.gov/health/reports/2013/ mental/rb_ mental.cfm.

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