Benefit Mandates

HR Policy Association is seriously concerned that the Department of Health and Human Services’ (HHS) state-based approach to defining “essential health benefits” will subject multistate employer plans to numerous different annual and lifetime limitation standards depending upon each state’s definition.  HR Policy believes that HHS should permit large multistate employers to select a reasonable uniform essential health benefits standard that would apply to their plans for the purposes of annual and lifetime restrictions.  Moreover, in order to keep coverage affordable through the state exchanges the Association believes that essential health benefits should be limited to medically necessary services as they have been historically defined in plan documents by employers and not expanded to include new technologies, drugs and services that have not proven to deliver greater effectiveness beyond existing approaches.