Defining Essential Health Benefits: Federal Guidance and New York Options

Author/Editor: Peter Newell

See the related press release.

The Affordable Care Act and subsequent federal guidance set minimum standards for “essential health benefits,” but also gave states much discretion to define those benefits by selecting a benchmark plan from a list of ten popular plans and supplementing those plans as necessary. States choosing this route must select a benchmark by the third quarter of 2012.

Defining Essential Health Benefits: Federal Guidance and New York Options, written by Peter Newell, explores options for New York policymakers in determining what “essential health benefits” will be required for all individual and small group policies for a transtional two-year period beginning in 2014. The report examines and compares the ten health benefit plans representing likely options for a New York benchmark plan and reviews benefit coverage in the context of current New York mandates and regulation. The report discusses the potential policy implications of the various choices and highlights key areas requiring further guidance and analyisis.

Defining Essential Health Benefits is the fifth in a series of ACA-related reports by the Fund that are supported by the New York State Health Foundation. Links to previous reports appear below.

Read the first report in this series, Building the Infrastructure for a New York Health Benefit Exchange: Key Decisions for State Policymakers. 

Read the second report in this series, Coordinating Medicaid and the Exchange in New York. 

Read the third report in this series, Two into One: Merging Markets and Exchanges under the Affordable Care Act. 

Read the fourth report in this series, Passive/Active: Defining the Role for a Health Benefit Exchange in the Interests of New Yorkers. 

Copyright: 2012
Published: 05.31.2012

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