Important health benefits ( EHBs ) have been established since the 2010 United States Affordable Care Act as a series of individually-purchased health insurance benefits in the United States and insurance plans on a small-scale group market, both inside and outside the Health Insurance Market should include for people. Exempt from EHB requirements is a large group health plan, an insured self-contained ERISA plan, and a multi-stakeholder regulation governed by ERISA that is not subject to state insurance laws.
Video Essential health benefits
Definisi
The 2010 Affordable Care Act (ACA) sets out the following ten essential health benefits categories, in Section 1302 (b) (1) ACA, codified at 42 U.S.C. Ã,§ 18022 (b):
Health insurance packages should include these benefits, that is, they should limit the expenditure of people outside the pockets and should not limit their annual and lifetime coverage.
Maps Essential health benefits
Mandatory for certain health insurance
The 2010 Affordable Care Act (ACA) defines the benefits of individually purchased health insurance in the United States and insurance plans in small group markets, both inside and outside the Health Insurance Market should include for people. Exempt from EHB requirements is a large group health plan, an insured self-contained ERISA plan, and a multi-stakeholder regulation governed by ERISA that is not subject to state insurance laws.
Interpretation
Important health benefits are the minimum federal standards and "states may require eligible health plans sold in state health insurance exchanges also include state-mandated benefits." The act provides "considerable wisdom" to the Secretary of Health and Human Services to determine, through regulation, any specific services within these classes is essential. However, the Act provides certain parameters that the secretary needs to consider. Secretary (1) must "ensure that the important health benefits reflect the right balance between categories... so that the benefits are not overly burdened in any category"; (2) may "not make coverage decisions, determine replacement rates, establish incentive programs, or design benefits in ways that discriminate individuals because of their age, disability, or expected length of life"; (3) should consider "health care needs of different segments of the population, including women, children, persons with disabilities, and other groups"; and (4) should ensure that important benefits "can not be denied to individuals against their desires on the basis of the expected age of the individual or life-age or current or predicted individual attendance, the level of medical dependence, or the quality of life. "
Menurut laporan Commonwealth Fund tahun 2011:
As it stands, federal regulations for 2014 and 2015 do not form a single, uniform national health care package. In contrast, the US Department of Health and Human Services (HHS) provides the state's policy to determine the specific benefits they deem important. This approach is well received by many state officials, who appreciate the opportunity to adapt bene fi ts to reflect the country's priorities, and by insurance companies, which maintain greater control over the design of benefits. However, groups representing consumers and providers are less supportive, expressing concern that the degree of flexibility found in the rules undermines the legal promise of consistent and meaningful coverage.
Legal history
The scope of essential health benefits is first required by the 2010 Patient Protection and Affordable Care Act (PPACA or ACA), which is a major part of health care reform legislation. The EHB provisions of the ACA are amendments to the Public Health Service Act. Lavarreda, director of health insurance studies for UCLA's Center for Health Policy Research, explained that prior to the ACA section, the US health insurance sector is experiencing a "down race, with insurance cutting benefits to lower premiums." The establishment of important health benefits "sets the standard for insurance.Anything below is not true health insurance." The EHB Terms shall come into force on 1 January 2014.
Revisions and revocation of essential health benefits schemes are proposed in the American Republic's section on the American Health Care Act 2017. Members of the Freedom Caucus Parliament lobbied during legislation discussions with House Speaker Paul Ryan to remove EHBs as a condition for approval of the AHCA bill.
Comparison with minimum essential coverage
Important health benefits should not be confused with essential minimum coverage ( MEC ). MEC is the minimum amount of coverage an individual must bring to fulfill an individual health insurance mandate, while EHBs are a set of benefits that a quality health plan (QHP) must offer. MEC is a low threshold; various forms of coverage that do not provide important health benefits are still considered as minimum essential coverage.
Note
Source
- Sara Rosenbaum, Joel Teitelbaum & amp; Katherine Hayes, Essential Health Benefit Terms of the Affordable Care Act: Implications for Persons with Disabilities, Commonwealth Funds (March 2011).
- Justin Giovannelli, Kevin W. Lucia & amp; Sabrina Corlette, Implementing the Affordable Care Act: Reviewing the Essential Health Benefits of the ACA, Commonwealth Fund (October 2014).
External links
- The Essential Health Benefits of HealthCare.gov
- Information on Essential Health Benefits (EHB) Benchmark Plan from Consumer Information and Insurance Monitoring Medicare and Medicaid Service Centers
Source of the article : Wikipedia
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