Rule making starts for essential health benefits

In 2014, when the rest of the Affordable Care Act kicks in, all health plans - whether they're sold inside the new online health exchange or outside - will be required to cover certain essential health benefits.

The essential health benefits will be based on the largest health plan in the small employer market -- Regence's Innova plan and must include all current state mandated benefits.

Specific coverages and any gaps that need to be filled will be determined through the rule making process started earlier this month, but all plans must include the following categories:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance abuse disorder services - including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services
  • chronic disease management
  • pediatric services, including oral and vision care
A public hearing to determine the specific coverages and any additional benefits that are needed will be held this fall. Check our website for updates or sign up to get rule-making notices.

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