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Insurers Doubt Feds HIX Readiness

Jacqueline Fellows, for HealthLeaders Media, February 27, 2013

States and insurers have also been waiting on other key details, such as the final rule for essential health benefits, which only got released a week ago. These are the benefits that, under the Patient Protection and Affordable Care Act (PPACA), insurers have to give patients who participate in the individual and small-group market next year.  

According to the final rule, an EHB package must be "equal in scope" to benefits offered by a typical employer plan and must include at least the following 10 EHB categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive, wellness services, and chronic disease management
  10. Pediatric services, including oral and vision care

States will still maintain regulatory control over how the plans that participate in the exchanges will meet the EHB requirements, but now that the final rule has been issued, insurers can start to design the plans they will offer and set prices.

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