Essential Health Benefits: What You Need to Know
Part of health care reform is a provision that certain plans include “essential health benefits” (EHBs) starting in 2014. Here’s what employers should know.
Beginning in 2014, health plans in the small group and individual market will be required to cover defined EHBs. The EHB package must include:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Each state will be required to establish an EHB benchmark package that small group and individual plans must match in terms of coverage.
The Department of Health and Human Services released FAQs with more guidance on how states may choose this benchmark plan. For instance, states will choose a benchmark plan in the third quarter of 2012, which will apply for 2014 and 2015. Access full FAQs here: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf.
Large group health plans and self-insured group plans are not required to cover EHBs under the health care reform law, but still have an obligation. These plans may not impose annual or lifetime dollar limits on benefits defined as an essential health benefit. Therefore, it is vital that large group and self-insured plans identify essential health benefits within their plan to ensure compliance.
Younger Workers Would Swap Pay for Benefits, Survey Says
A growing number of workers, particularly those under 40, would be willing to give up some pay for more secure retirement and more generous health benefits, according to a recent Towers Watson survey. Also:
- Sixty-three percent of younger employees and 40 percent of all employees fear their retirement benefits will be cut in the next two years.
- Even more are concerned about higher out-of-pocket health care costs and copays in the next two years.
- Rising health care costs was the top reason employees are concerned about retirement security (64 percent) .
Clearly, your health care and retirement benefits package are more important than ever to current and potential employees. Make sure you communicate your health and retirement benefits effectively, so employees know the full value available to them through your plans.
DID YOU KNOW
Over 17 million people (one in every 12 adults) suffer from alcohol abuse or dependence.
April is Alcohol Awareness Month—take this time to make sure your workplace provides a safe, healthy environment for employees.
Ensure you have proper alcohol-related policies, supervisor training to spot alcohol use or related issues, and an employee assistance program so employees can get help if needed.
