The proposed regulations governing essential benefits that must be included in health care plans sold through exchanges provides states and insurers “a high level of flexibility,” according to an analysis.
The rules were proposed by the Department of Health and Human Services (HHS) on Wednesday. The comment period on the rules closes December 26.
States or the federal government will operate the exchanges, with some states deciding not to participate as a political issue.
However, currently, the deadline for when states must select a health insurance plan to serve as a “base-benchmark” for the coverage to be offered on and off the exchanges for benefit years 2014 and 2015 is now shortly after Christmas, according to Beth Mantz-Steindecker of Washington Analysis. It was originally October 1.
The 131 pages of proposed rules are designed to carry out the mandates under PPACA and govern the individual and small-group markets.
They go into effect in January 2014. The law also mandates that people with pre-existing conditions cannot be denied coverage.
Analysts at Washington Analysis in Washington said the essential health benefits (EHB) proposal seeks to minimize market disruption and is largely consistent with what the analysts expected and what was foreshadowed by HHS in prior directives.
“Although the rule provides few specifics with respect to the individual services that must be covered, outside of the 10 broad benefit categories outlined in the health reform law, the EBH regulation is largely benign for health insurers and is largely premised on plans that are already widely offered in state markets,” the analysts said.
“While stakeholder groups have been critical of a potential expansion of prescription coverage beyond original guidances, which was proposed today, we do not anticipate this to have a significant impact on insurers,” the analysts said.
The analysts said that HHS now estimates that 1,200 plan issuers will each offer 15 potential qualified health plans (QHPs), for a total of 18,000 potential QHPs.
“These reforms are really at the heart of the Affordable Care Act,” said Gary Cohen, director of the Center for Consumer Information and Insurance Oversight of the Centers for Medicare and Medicaid Services at HHS.
At the same time, it is clear that the law and new rules governing sales to these markets greatly expand the potential market for both insures and agents.
According to the rule, in 2011, only 10.8 million people were enrolled in the individual insurance market, while 48.6 million lacked insurance.