Essential Health Benefits Selected for Wyoming
The Affordable Care Act (ACA) lists 10 broad categories of Essential Health Benefits (EHB) that must be included in individual and small group plans offered beginning January 1, 2014. These benefits will apply both inside and outside the federal Health Insurance Marketplace operated in Wyoming. The 10 categories of benefits are:
· Ambulatory services,
· Emergency services,
· Maternity and newborn services,
· Mental health and substance abuse disorder treatments, including behavioral health treatments,
· Prescription drugs,
· Rehabilitative services and habilitative services and devices,
· Laboratory services,
· Preventive and wellness services, and
· Pediatric services, including vision and oral care.
Beginning in January 2014, health plans inside or outside the federal Health Insurance Marketplace, must offer benefits that are “substantially equal” to the benefits of the benchmark plan. Because the benchmark plan essential health benefits are based on 2012 plan designs, and include state-required benefits that were enacted before December 31, 2011, some of the benchmark plan summaries may not reflect requirements effective for plan years starting on or after January 1, 2014. Therefore, when designing plans that are substantially equal to the EHB-benchmark plan, beginning in 2014, insurance companies may need to conform policy benefits, including coverage and limitations, to comply with these requirements and limitations.
Because Wyoming declined to select a benchmark plan, the state defaulted to the federally-selected plan, the largest small group plan offered in the state on December 31, 2011. Therefore, the benchmark essential health benefit plan for Wyoming is Blue Cross Blue Shield’s Blue Choice Business plan.
The federal Centers for Medicare & Medicaid Services (CMS) posted to its website information regarding the default plan selected for Wyoming, a guide to reviewing the benchmark plan and a list of Wyoming mandated benefits as of December 31, 2011. The information is located on CMS’ website at: http://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html.