Obamacare has many important pieces, including reforms to private health insurance. Starting in 2014 all insurance plans sold to individuals and small businesses must cover certain benefits, creating consistency and transparency for all Americans.

Known as “Essential Health Benefits,” there are ten benefits they will have to provide: 

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management, and
  • Pediatric services, including oral and vision care

In December, 2011 the United States Department of Health and Human Services (HHS) released a bulletin which gave states the option of defining their own EHB plans. However, the bulletin said states must pick between 10 options for their plans.  These include:

  • One of the three largest small group plans in the state by enrollment;
  • One of the three largest state employee health plans by enrollment;
  • One of the three largest federal employee health plan options by enrollment;
  • The largest HMO plan offered in the state’s commercial market by enrollment.  

Colorado is currently in the process of picking our plan. Today the Division of Insurance, the Colorado Health Benefits Exchange and the Office of the Governor hosted a webinar with data about these different plans in Colorado.

However, choosing one of these plans may prove to be difficult for states. The plans cover different benefits depending if they are regulated by the state or by the federal government. If a state chooses a state regulated plan with additional coverage mandates other than the EHB benefits, the costs for the plans go up.  According to HHS a state can choose one of the plans they regulate and the federal government will pay the additional costs for these plans for two years. However, according to HHS’s bulletin, in 2016 states may have to cover the additional costs for these benefits. HHS will decide this in 2016. For more information see the HHS bulletin and Frequently Asked Questions.  View Colorado’s plan options benefit description forms, which provide an explanation of the benefits and exclusions the plan provides. 

The next steps for choosing Colorado’s EHB plan include stakeholder meetings for the public to provide input as well as ask questions about the plan options.  The first meeting is being held on Wednesday, July 18th from 10-12 a.m. at National Jewish Hospital (1400 Jackson Street, Denver, Colorado) and the second will be on Tuesday, July 31st from 1-3 p.m. at the History Colorado Center (1200 Broadway, Denver, Colorado).  In preparation for the meetings the Division of Insurance is collecting questions to prepare on Frequently Asked Questions handout.  You can email questions to ehb@dora.state.co.us.  

Throughout this process DOI is collecting comments to help in choosing the Colorado’s plan.  Comments will be taken until August 5th at ehb@dora.state.co.us.  The public can also send comments to the United States Department of Health and Human Services at EssentialHealthBenefits@cms.hhs.gov.

For more information please also see this HHS fact sheet on the Essential Health Benefits Bulletin.


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