Essential health benefits

Beginning in 2014, the Affordable Care Act requires that all small group and individual insurance plans provide a minimum level of benefits known as “essential health benefits.” This requirement applies to plans sold through the health insurance exchange and plans sold outside the health insurance exchange. It does not apply to large, employer-sponsored plans. Section 1302 of the Affordable Care Act defines 10 broad categories of services that make up the essential health benefits. These categories are 1.) ambulatory patient services, 2.) emergency services, 3.) hospitalization, 4.) maternity and newborn care, 5.) mental health and substance use disorder services (including behavioral health treatment), 6.) prescription drugs, 7.) rehabilitative and habilitative services and devices, 8.) laboratory services, 9.) preventive and wellness services and chronic disease management, and 10.) pediatric services, including oral and vision care.

Under the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) became responsible for determining what specific services within those broad categories would be included in the essential health benefits package. In December 2011, HHS announced that it would let states select the services in their essential benefits package, based on benefits in existing plans offered in each state.

Arkansas’s implementation

Arkansas has established a Plan Management Advisory Committee to help define the essential health benefits for the state. On May 18, 2012, the group selected the Blue Cross Blue Shield PPO as the benchmark plan it recommended to the benefits exchange Steering Committee. On May 25, the Steering Committee voted, instead, to recommend any of the state's three small group plans as the essential health benefits benchmark. The issue is currently before the Arkansas Insurance Commissioner for a final decision.

Federal Documents

Arkansas Documents