A little more than six months before open enrollment begins, 24 states and Washington, D.C., have chosen a benchmark plan that will determine what health insurers must cover in health plans sold in the state exchanges and individual and small-group markets, according to a new study from the Commonwealth Fund.
In the rest of the country, the snapshot suggests, the federal government will model the minimum benefits on the largest small-group plan sold in the state. Under the Patient Protection and Affordable Care Act, individual and small-group plans must offer an “essential health benefits” package. The core set of benefits must cover 10 broad categories, such as emergency services, maternity and pediatric care, prescription drugs, and mental health and substance-abuse services. HHS issued a final rule in February on essential benefits for 2014 and 2015 and will revisit the provisions for the 2016 benefit year.
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