Illinois Begins Essential Health Benefits Discussion

Governor Pat Quinn recently announced that the benchmark plan for Illinois’ Essential Health Benefits (EHB) package will be chosen by September 30, in order to meet the Federal deadline for selecting a plan. A public meeting on Wednesday, September 12th, will provide the public and other stakeholders an opportunity to weigh in on this crucial piece of the health care law’s implementation in Illinois.

The EHB package defines the baseline of services covered by health insurance plans offered to individuals and small businesses in the state.

Last December, The Department of Health and Human Services released a bulletin with guidelines for states to select their own EHB plans. The guidelines feature 10 different categories of benefits that each plan must cover, such as “emergency services,” “rehabilitative and habilitative services,” “prescription drugs,” and “mental health and substance abuse services.”

States must select a health insurance plan that is currently operating within the state to act as the EHB benchmark, with the largest small group market plan in the state acting as the default benchmark if the state fails to meet the September 30 deadline. If the selected plan does not provide adequate coverage of one of the ten benefits categories, that category will be supplemented with a coverage package from a different potential plan.

Once selected, the EHB will define the level of care that individual and small group insurance plans must offer in Illinois. Benchmark plans can specify the scope or duration of benefits, but they cannot place dollar limits on copays or deductibles, as well as lifetime annual dollar limits on coverage. Plans offered to consumers in health insurance exchanges will be required to meet the level of coverage ensured by the EHB package. However, insurance companies will have the opportunity to make substitutions within the ten categories of benefits, as long as those substitutions are not found to reduce the value of coverage offered.

The Illinois Health Care Reform Implementation Council will be hosting a meeting on Wednesday, September 12, 2012, where the public and other stakeholders will be able to make comments on the state’s EHB selection. The committee will continue to accept comments until September 19. Comments can be submitted through the Governor’s health reform website.

Check back soon for an update on the EHB selection process following Wednesday’s meeting!