Coalition urges flexibility on essential health benefits

The Essential Health Benefits Coalition—which includes employer trade associations, pharmacy benefit managers and health plans—urged federal health officials to give health plans flexibility as they develop benefit packages to comply with essential health benefit rules under healthcare reform.

The Patient Protection and Affordable Care Act mandates coverage in the individual and small-group markets across 10 categories of care and these “essential benefits” will be modeled after a benchmark health plan selected in each state.

The coalition called for “the maximum amount of flexibility” for health plans as they seek to offer benefit packages that will meet benefit thresholds set by the benchmark plan selected in each state, according to a news release.

The coalition endorsed an Institute of Medicine recommendation for a premium target tied to the average cost of a small-business health plan. The coalition also said benefits not typically included in small group plans should be excluded, as should Medicare requirements. Benefits should be evaluated for their medical effectiveness and costs, the coalition said. Health plans should also be allowed to apply annual dollar limits to benefits deemed not essential, the coalition said.

“HHS has an opportunity to develop an essential health benefits package that is both affordable and flexible to ensure that workers can get the health coverage they need,” Stacey Rampy, executive director of the coalition, said in a news release.

Coalition members include America’s Health Insurance Plans; the Blue Cross and Blue Shield Association; Express Scripts; the National Association of Manufacturers; and the U.S. Chamber of Commerce.