From the Centers for Medicare and Medicaid Services:
Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State Summary
This document provides illustrative information to complement the bulletin on essential health benefits (EHB) under the Affordable Care Act released on December 16, 2011. Specifically, it provides a list of the products with the three largest enrollments in the small group market in each State using data from HealthCare.gov. It provides the names of the three largest products in each State ranked by enrollment. In addition, we are providing a list of the top three nationally available Federal Employee Health Benefit Program (FEHBP) plans based on enrollment. This information is being provided to facilitate a better understanding of the intended approach to EHBs.
Background
Non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges along with certain other types of plans must cover EHBs beginning in 2014.1 Section 1302(b)(1) of the Affordable Care Act provides that EHB include items and services within 10 statutorily defined benefit categories. Section 1302(b)(2) instructs the Secretary that the scope of EHB shall equal the scope of benefits provided under a typical employer plan. On December 16, 2011, the U.S. Department of Health and Human Services (HHS) released a bulletin describing its intended approach to defining the essential health benefits under the Affordable Care Act. Under the Department’s intended approach, States would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the EHB package. All 10 statutory categories in section 1302(b)(1) of the Affordable Care Act must be included as a part of EHB; if the benchmark does not initially cover a category, the benchmark must be supplemented. States could choose a benchmark from among the following health insurance plans:
• the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market; • any of the largest three State employee health benefit plans by enrollment; • any of the largest three national FEHBP plan options by enrollment; or • the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.
Purpose
To provide consumers, employers, issuers, States, and other stakeholders with additional information about the small group products in each State, HHS is releasing a list of the largest three small group products in each State according to data collected by HealthCare.gov based on June 30, 2011 enrollment HHS collects data from issuers of individual and small group major medical insurance on their products, as required by the Affordable Care Act. The information in this document is provided for illustrative purposes and is not an official list of products that will be benchmark options for State consideration. HHS is still collecting and reviewing public comment on the EHB bulletin and will subsequently release regulations.
The list below includes small group products that are open for enrollment as well as products that are closed but still active. Any products that are association products or that are not major medical plans are not included.
Additionally, we are providing a list of the top three nationally available Federal Employee Health Benefit Program (FEHBP) plans based on March 31, 2011 enrollment data.
Ashley Behrle
