The October 27 Health Law Update, “Methods and Criteria to Define ‘Essential Health Benefits’ Unveiled,” by Tax and Personal Planning Partner Jennifer Mills, Tax Associate Susan Whittaker Hughes and Associate Chad Makuch was featured in Law 360 on November 18.
The update explains that “one of the most fundamental tasks remaining under the Patient Protection and Affordable Care Act (PPACA) is to define the package of ‘essential health benefits’ that certain health insurance plans will be required to offer beginning in 2014. PPACA requires that private health insurance plans be offered to individuals and small employers through state-created health insurance exchanges in 2014. These plans are required to offer essential health benefits. Although the specific benefit package that will constitute essential health benefits has not yet been determined by Health and Human Services (HHS), the Institute of Medicine (IOM) recently released its report recommending to HHS a set of methods and criteria to use to define essential health benefits.”
The Baker Hostetler Health Law Update lists the ten categories from which medical care for the essential health benefits must come, in addition to noting a three-tiered set of criteria for evaluating employee health benefits: criteria to evaluate the aggregate package of benefits offered; criteria to evaluate the individual component benefits offered; and criteria to evaluate the methods for defining and updating benefits offered.