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Comprehensive Health Coverage – Essential Health Benefits Package

Comprehensive health coverage, known as the essential health benefits package, is required for plan years beginning on or after January 1, 2014. The Affordable Care Act (ACA) requires non-grandfathered health insurance plans in the individual and small group markets to:

  • Provide either a bronze, silver, gold or platinum level of coverage (or a catastrophic plan in the individual market);
  • Limit cost-sharing for essential health benefits; and
  • Cover a core set of items and services, known as essential health benefits.

The Department of Health and Human Services (HHS) created a transition policy in 2013 that allowed issuers in the individual and small group markets to renew health insurance policies that do not comply with the essential health benefits requirement effective in 2014. The transition policy was originally planned to last one year, however the policy has been extended to policy years beginning on before October 1, 2016.

If an issuer is using the transition relief, and not including the essential health benefits package, it is required to send notice to the employer outlining which ACA reforms are not included in the health plan coverage.

Learn more by reading our full Healthcare Reform Legislative Brief.