HHS Issues Comprehensive “Essential Health Benefits” Proposed Regulations


Commencing in 2014, the Patient Protection and Affordable Care Act (Act) requires that health insurance coverage provided in the individual and small group markets, including coverage offered through American Health Benefit Exchanges (or, simply “exchanges”), provide “essential health benefits.” This requirement is part of a larger regulatory scheme that includes:

..A requirement that all U.S. citizens age 18 and over maintain health insurance coverage;

..Premium support (in the form of advanceable, refundable tax credits and cost-sharing subsidies) to help low- and moderate-income individuals afford coverage and pay for benefits; and

..Obligations on large employers (i.e., those with 50 or more full-time equivalent employees) that penalize the failure to offer comprehensive, affordable coverage to full-time employees (this requirement is referred to as “employer shared responsibility”).

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