© 2011, National Association of Health Underwriters • www.nahu.org

Why Define an Essential Benefits Package?

• A key goal of ACA is to improve access to health insurance coverage.

• It included a number of changes to the way the existing health insurance market works to make coverage more broadly available to everyone.

• In order for these market reforms to function effectively, ACA includes a requirement for everyone to have health insurance coverage.

• This means that it is necessary that we define what the minimum level of coverage is to meet this requirement.

© 2011, National Association of Health Underwriters • www.nahu.org

How are people covered today?• The vast majority of people who already have health

insurance coverage today are covered by their employers, both large and small

• Employer coverage in both the small and large group market is extremely comprehensive

• In December of 2011, NAHU conducted a survey of our membership regarding the benefits included in group health plans.

© 2011, National Association of Health Underwriters • www.nahu.org

NAHU Survey

• The survey indicates that people with employer sponsored coverage receive emergency care and hospital care under every health care plan.

• Follow up care such as in patient rehab, nursing facilities, and hospice care are covered by 97, 93 and 90 % of small group plans respectively.

• Prenatal, delivery and infant care along with organ transplants and prescriptions are also covered by nearly every plan.

© 2011, National Association of Health Underwriters • www.nahu.org

The Benchmark plans

• The use of benchmarks highlights the already comprehensive nature of employer sponsored coverage today.

• The benchmarks do not create absolute uniformity, due to the variety of potential plan selections, and the difference in mandates from state to state.

• Some have speculated that some states may even have benchmarks that continuously change between now and 2014, as state legislatures add new state required benefits.

• The HHS bulletin indirectly says that mandates will be retained at their current level, but additional clarification is needed in this area.

© 2011, National Association of Health Underwriters • www.nahu.org

More on State Mandates

• Using benchmarks allows states to more quickly create the qualified plans that must be offered through the Exchange in 2014.

• The disadvantage of this approach is that state mandates differ widely from state to state.

• Not all of the mandates required by states have been demonstrated to be both cost-effective and evidence based.

• Additionally, benchmark plans may include items and services outside of the 10 categories specified by ACA.

© 2011, National Association of Health Underwriters • www.nahu.org

Essential benefits and Affordability

• One of the most commonly asked questions related to implementation of health reform relates to affordability.

• Employers are concerned about whether they will be able to continue to offer coverage to their employees.

• Employees are concerned about whether they will be able to afford their share of the cost of coverage.

• Individuals are concerned about whether benefit requirements will increase their costs.

• If cost is not taken into account, it will be difficult for small employers and individuals to continue to purchase coverage.

• The result could be diminished access to care and soaring public health care costs, despite the best intentions of ACA to avoid these outcomes.