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Issues close to home: Essential Health Benefits

Eric LeGrand doing Locomotor Training at a NeuroRecovery Network facitlityUnder the new health care law, most health insurance plans will be required to cover at least the following essential health benefits (EHB): ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

Coverage of habilitative services is particularly significant for the disability community, but it remains to be seen how states will move forward in assuring those benefits are covered.

On November 20, the Department of Health and Human Services (HHS) released an updated EHB rule. Though HHS allows the states flexibility to design their own benchmark plans, the rule says that if the EHB plan does not include coverage for habilitative services, it must include habilitative services that either provide parity by covering habilitative services benefits that are “similar in scope, amount and duration” to benefits covered for rehabilitative services, or are determined by the issuer and reported to HHS. In the latter instance, the flexibility to determine rehabilitative coverage would be left up to insurers.

The Reeve Foundation is paying close attention to what other groups are doing as things develop. As we continue to learn more about the EHB rule, we will keep you updated and provide you with the important information you need.

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Continue Christopher Reeve's LegacyPhoto by Timothy Greenfield-Sanders