PPACA Essential Benefits Outlined

The Department of Health and Human Services (HHS) essentially gave in a little on crafting rigorous essential benefits under the Patient Protection and Affordable Care Act (PPACA) and punted the final decisions to states. PPACA called for HHS to set essential benefits for non-grandfathered health benefits under health reform and outlined 10 categories of services that must be covered. Earlier this year, the Institute of Medicine (IOM) upset advocates’ dreams of having rich essential benefits mandated nationwide when it recommended a cost-effectiveness strategy in setting the benefits that come into play in 2014. Among other strategies, IOM said that essential benefits should be benchmarked against the actuarial value of a typical small business employer plan.

Final Rules Don’t Give Relief on Minimum MLR: Mixed Signals from HHS On States’ PPACA MLR Waivers

When the national health reform bill passed, many insurers and state insurance regulators reacted with chagrin to the 85 percent large group and 80 percent individual and small group minimum medical loss ratio (MLR) requirements in the act. They argued that the minimum MLR thresholds would destabilize these markets and lead to insurers exiting these products. Of most concern was the individual market segment.