U.S. Department of Health & Human Services
News Division
202-690-6343
FOR IMMEDIATE RELEASE
Wednesday, February 20, 2013
Health care law allows consumers to easily find and compare options starting in 2014
New rule will expand mental health and substance use disorder benefits to 62 million Americans
Department
of Health and Human Services (HHS) Secretary Kathleen Sebelius today
announced a final rule that will make purchasing health coverage easier
for consumers. The policies outlined today will give consumers a
consistent way to compare and enroll in health coverage in the
individual and small group markets, while giving states and insurers
more flexibility and freedom to implement the Affordable Care Act.
“The
Affordable Care Act helps people get the health insurance they need,”
said Secretary Sebelius. “People all across the country will soon find
it easier to compare and enroll in health plans with better coverage,
greater quality and new benefits.”
Today’s
rule outlines health insurance issuer standards for a core package of
benefits, called essential health benefits, that health insurance
issuers must cover both inside and outside the Health Insurance
Marketplace. Through its standards for essential health benefits, the
final rule released today also expands coverage of mental health and
substance use disorder services, including behavioral health treatment,
for millions of Americans.
A
new report by HHS, also released today, details how these provisions
will expand mental health and substance use disorder benefits and
federal parity protections for 62 million more Americans.
In the past, nearly 20 percent of individuals purchasing insurance didn’t have access to mental
health services, and nearly one third had no coverage for substance use
disorder services. The rule seeks to fix that gap in coverage by
expanding coverage of these benefits in three distinct ways:
(1) By including mental health and substance use disorder benefits as Essential Health Benefits
(2) By
applying federal parity protections to mental health and substance use
disorder benefits in the individual and small group markets
(3) By
providing more Americans with access to quality health care that
includes coverage for mental health and substance use disorder services
To
give states the flexibility to define essential health benefits in a
way that would best meet the needs of their residents, this rule also
finalizes a benchmark-based approach. This approach allows states to
select a benchmark plan from options offered in the market, which are
equal in scope to a typical employer plan. Twenty-six states selected a
benchmark plan for their state, and the largest small business plan in
each state will be the benchmark for the rest.
The
rule additionally outlines actuarial value levels in the individual and
small group markets, which helps to distinguish health plans offering
different levels of coverage. Beginning in 2014, plans that cover
essential health benefits must cover a certain percentage of costs,
known as actuarial value or “metal levels.” These levels are 60 percent
for a bronze plan, 70 percent for a silver plan, 80 percent for a gold
plan, and 90 percent for a platinum plan. Metal levels will allow
consumers to compare insurance plans with similar levels of coverage and
cost-sharing based on premiums, provider networks, and other factors.
In addition, the health care law limits the annual amount of cost
sharing that individuals will pay across all health plans – preventing
insured Americans from facing catastrophic costs associated with an
illness or injury.
Policies
in today’s rule also provide more information on accreditation
standards for qualified health plans (QHPs) that will be offered through
the Health Insurance Marketplaces (also known as Exchanges), one-stop shops that will provide access to quality, affordable private health insurance choices.
Together,
these provisions will help consumers compare and select health plans in
the individual and small group markets based on what is important to
them and their families. People can make these choices knowing these
health plans will cover a core set of critical benefits and can more
easily compare the level of coverage based on a uniform standard.
Further, these provisions help expand choices and competition on the
Marketplaces.
For more information on today’s rule, visit: http://cciio.cms.gov/ resources/factsheets/ehb-2-20- 2013.html
To view the rule, visit: http://www.ofr.gov/inspection. aspx
For more information on how today’s rule helps those in need of mental health and substance use disorder services, visit: http://aspe.hhs.gov/health/ reports/2013/mental/rb_mental. cfm
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