In a major move forward on implementation of the Affordable Care Act, the Department of Health and Human Services and the U.S. Department of Labor jointly released several proposed rules on Tuesday offering more guidance on essential health benefits, insurance reform and workplace wellness plans.
One rule offers much-anticipated guidance on essential health benefits and “benchmark” plans. Essential health benefits, the ten categories of services that must be covered by most plans, are broad in scope, so it’s up to states now to actually choose a plan that will serve as a benchmark for which specific services must be covered. Many states have, in fact, already been working to identify their benchmark plans, but with the release of this rule, HHS has extended the deadline for states to make their decision until the end of December.
The National Association of Health Underwriters said it was “pleased to see that HHS recognizes the states’ authority to regulate health insurance.”
Also released was a rule outlining the major insurance reforms set to go into effect in 2014. While many consumer protections are already in place, such as ban on denying coverage to children with preexisting conditions, other protections are coming. New rules would ban insurers from denying adults with preexisting conditions and deny insurers from tying insurance premiums to health status. They received praise by health and consumer advocacy groups.
“These rules make clear that the practice of putting the sickest people into one insurance product, causing their premiums to get increasingly higher, will no longer be permitted,” said Ron Pollack executive director of Families USA.
The third rule released allows employer-based discounts on insurance premiums to those who meet certain health outcomes – cholesterol, BMI, etc. The law raises the maximum reward for participating in certain employer-based wellness programs from 20 to 30 percent of the cost of coverage and up to 50 percent for participating in tobacco prevention or cessation programs. In addition, the rules make changes aimed at reducing discriminatory practices in such programs. Read the rule or this fact sheet.
“The Affordable Care Act recognizes that well-run, equitable workplace wellness programs allow workers to access services that can help them and their families lead healthier lives,” said Secretary of Labor Hilda L. Solis. “Employers, too, can benefit from reduced costs associated with a healthier workforce.”
States now have a 30-day period to comment on the rules. You can weigh in on the rules, too, by submitting your comments at regulations.gov.