Preparing for 2014: HHS Releases Final Rule on Essential Health Benefits


Julia Loyd and Shawn Gilman, Associates in the Health Care and Life Sciences practice, in the Washington, DC, office, co-wrote an article titled "Preparing for 2014: HHS Releases Final Rule on Essential Health Benefits."

Following is an excerpt:

On February 25, the U.S. Department of Health & Human Services (HHS) published a final rule regarding standards for essential health benefits (EHBs) and actuarial values (AVs). Beginning in 2014, the final rule's requirements are applicable to all non-grandfathered health insurance coverage in the individual and small group markets. The final rule largely adopts the proposals set forth in the EHB proposed rule published on November 26, 2012, including the requirement that such issuers cover items and services in 10 benefit categories, as originally identified in the Patient Protection and Affordable Care Act (ACA). Additionally, the final rule sets forth a timeline for qualified health plans (QHPs) to be accredited in affordable insurance exchanges (Exchanges), as well as an application process for recognizing additional accrediting entities for certifying QHPs. This summary seeks to provide readers with an overview of the main aspects of the final rule.