Essential Health Benefits Coalition Submits Comments to HHS on Proposed Rule

Dec 21, 2012, 17:42 ET from Essential Health Benefits Coalition

WASHINGTON, Dec. 21, 2012 /PRNewswire-USNewswire/ -- Today, the Essential Health Benefits Coalition (EHBC) submitted comments on the proposed rule, "Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation," issued by the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) and published in the November 26, 2012 Federal Register.

"First and foremost, we need to ensure that health care coverage in the small group and individual markets is affordable," explained Stacey Rampy, Executive Director of the EHBC. "The coalition has carefully reviewed the proposed rule and, while the rule contains some positive elements, it also includes some proposed language that will unnecessarily compromise our goal of protecting affordable coverage. We urge the Administration to release a final rule that promotes the availability of high-quality affordable coverage options, while ensuring that the essential health benefit requirements are not so overly comprehensive that they increase the cost of all coverage beyond the reach of small businesses, their employees and individuals."

In its comments submitted to HHS, the EHBC stressed the importance of encouraging private sector benefit design, medical management and care delivery approaches to promote the availability of high-quality coverage that is also affordable. The EHBC believes that the final rule could best maintain these strategies by permitting plans flexibility in the implementation of benefit design, allowing plans to offer prescription drug coverage that is consistent with the categories and classes set forth in the EHB-benchmark, and permitting the employer's contribution to a HRA or HSA plan to be counted for purposes of actuarial value and deductible requirements.

Additionally, the EHBC emphasized that, to help better ensure coverage in the small group and individual markets is affordable, benefits in the EHB-benchmark should include only those benefits typically offered under small group plans.

"We are hopeful that our comments will be carefully considered and incorporated into the final rule and look forward to a final rule that balances the goals of coverage and affordability," added Rampy.

The EHBC has long maintained that there are four essential criteria that HHS' final essential benefits package must satisfy:

  • The essential health benefits package must be affordable. It should provide basic services that Americans need to protect their health, not expansive coverage that is unaffordable for individuals or small employers.
  • The package must be flexible. It should give individuals and employers the choice to purchase a range of plans and options, and it must allow for flexibility in insurance design and cost-sharing arrangements.
  • The package should make it easier for employers to offer, and individuals to obtain coverage. Our economy needs businesses to grow and hire more workers – a benefits package that is too expensive will hinder business and job growth.
  • The package must consider all costs associated with its development. Taxpayer costs will greatly increase if more employers are priced out of offering coverage, further threatening America's fiscal future.

About the Essential Health Benefits Coalition (EHBC)

The EHBC is a broad-based organization representing large and small employers from various sectors of the U.S. economy, pharmacy benefit managers, health plans and health care providers who are committed to adoption of an essential health benefits package that is affordable and flexible in order to better enable employers and individuals to obtain and maintain health care coverage. To learn more please visit  

SOURCE Essential Health Benefits Coalition