Alert: Essential Health Benefits - Now What?

Dear Partners,

Earlier this year, the Center for Consumer Information and Insurance Oversight (CCIIO) outlined a process for states to choose Essential Health Benefits (EHB) packages, a benchmark of ten benefit areas that all individual and small group health plans must cover going forward. While EHBs show promise, the policy will only be successful in increasing the quality of health coverage if health plans comply.

Consumer advocates have an opportunity to ensure EHB works and to improve benefits in the future. EHB is a major improvement for insurance, but because many benefits are new additions to private insurance plans, challenges may emerge. Consumer advocates can use this time to monitor EHB implementation to make sure it is working the best it can for consumers and to track gaps in coverage.

Community Catalyst has developed two issue briefs to guide consumer advocates in this work. 

  • An overview of key EHB issues to watch. This brief identifies six areas, including women’s health, LGBT non-discrimination standards, pediatric dental, and mental health and substance use disorder services, for advocates to monitor in relation to EHB. Community Catalyst suggests identifying one or two issues that are most strategic and relevant to your area of advocacy.
  • EHB advocacy strategies. This brief provides a timeline for EHB implementation, a broad advocacy strategy, and targeted ideas for monitoring. Strategies focus on educating your coalition, working with state Departments of Insurance, and collecting data and consumer stories.

We hope you will find these materials helpful as consumers begin using health plans and potentially having challenges. We would love to hear how you have used any of these tools and resources. Please contact Christine Barber, at cbarber@communitycatalyst.org with questions or feedback.

Thank you for your continued advocacy,

The Community Catalyst Private Insurance Team 

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