ACA Update: EHBs, AVs, Accreditation

ACA Update: EHBs, AVs, Accreditation

Thursday, February 21, 2013

HHS released a final rule on February 20, 2013 outlining standards for health insurance issuers regarding Essential Health Benefits (EHBs) that must be included in all individual and small group plans, along with a definition of actuarial value for plans, and a timeline for accreditation of Qualified Health Plans. Read a fact sheet on the EHB final rule and the final rule.

  • The rule on EHBs is designed to provide consistency across plans, provide a core set of services that are equal in scope to those offered by typical employer plans (defined by a state-specific benchmark plan), and limit out-of-pocket expenses for consumers.
  • The rule also defines the actuarial value (AV) for plans offered on Marketplaces. AV is the percentage of cost for covered benefits that a health plan will cover. For example, an AV of 90% means the plan would cover 90% of costs and the consumer would cover 10% of costs. Marketplaces will offer plans at "metal levels" set for various AVs: 60 percent for a bronze plan, 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan.
  • Finally, the rule outlines a timeline for accreditation of Qualified Health Plans (QHPs), which are the approved plans to be offered in Marketplaces. QHPs must meet certain requirements, such as providing Essential Health Benefits (EHBs) as required by ACA. Since states regulate health insurance, QHPs must also comply with state licensure requirements.


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