Employers seek clarity on health reform law mandate on essential benefits

Despite rules that require mental health, behavioral health and substance abuse treatment be included as essential health benefits in 2014, employers say they need more clarification on the benefits that will vary greatly by state.

Final rules the U.S. Department of Health and Human Services issued in February say mental and behavioral issues must be included in 10 categories of essential health benefits that individual and nongrandfathered small-group health plans must offer in 2014. The rules also require that mental health benefits be paid at parity with medical benefits, following a similar 2008 mandate on large employers.

But the rules allow each state to mandate which mental/behavioral services to provide, so the cost and coverage effect on small employers will vary.

In addition, the rules say essential benefits must be equal in scope to benefits offered by a “typical employer plan.” To meet the requirement, each state designates a benchmark plan or defaults to the plan sold to most small groups in that state.

Continue Reading…