Arkansas Administrative Code › Agency 054 - Arkansas Insurance Department › Rule 054.00.12-001 - Rule 103: Essential Health Benefits Benchmark Plan

Current through Register Vol. 49, No. 6, June, 2024
Section 1.
Authority
This Rule is issued pursuant to the authority granted the
			 Arkansas Insurance Commissioner ("Commissioner") under Ark. Code Ann. §
								23-61-108(b)(1)
			 to promulgate rules and regulations necessary for the effective regulation of
			 the business of insurance or as required for this State to be in compliance
			 with federal laws. In addition, under Ark. Code Ann. §
								23-61-108(b)(2),
			 the Commissioner has authority to coordinate regulatory activities and
			 administration with the federal government with respect to the regulation of
			 insurance.
Section 2.
Scope
This Rule applies to all non-grandfathered "qualified health
			 plans" as defined by Section 1301 of the Patient Protection and Affordable Care
			 Act of 2010, as amended by the Health Care and Education Reconciliation Act of
			 2010 ("Affordable Care Act") as well as to, by virtue of Section 1201 of the
			 Affordable Care Act, which added Section 2707(a) to the Public Health Service
			 Act, all non-grandfathered health plans offered in the individual and small
			 group markets outside the Exchange in the State.
Section 3.
Purpose &
		  Background
The purpose of this Rule is to comply with requirements issued by
			 the Department of Health and Human Services ("HHS") for states to select a
			 benchmark health plan before September 30, 2012 to serve as the standard for
			 providing essential health benefits (EHB) in non-grandfathered health plans
			 offered through the Exchange operating in the State as well as to
			 non-grandfathered plans offered in the individual and small group markets
			 outside the Exchange in the State.
Section 1302 (b) of the Affordable
		  Care Act directs the Secretary of HHS ("Secretary") to define essential health
		  benefits (EHB) for health plans subject to the Affordable Care Act. Under the
		  Affordable Care Act, non-grandfathered plans in individual and small group
		  markets both inside and outside of the Exchanges must provide EHB beginning in
		  2014. Section 1302(b) of the Affordable Care Act provides that EHB include
		  items and services within the following ten (10) benefit categories:
(1) ambulatory patient services,
(2) emergency services,
(3) hospitalization,
(4) maternity and newborn care,
(5) mental health and substance use disorder
		  services, including behavioral health treatment,
(6) prescription drugs,
(7) rehabilitative and habilitative services
		  and devices,
(8) laboratory
		  services,
(9) prevent wellness
		  services and chronic disease management, and
(10) pediatric services, including oral and
		  vision care. Section 1302(b)(2) requires that the Secretary provide that the
		  scope of EHB be equal to benefits provided under a "typical employer plan."
On December 16, 2011, HHS issued "Essential Health Benefits: HHS
			 Informational Bulletin," and thereafter on January 25, 2012, "Essential Health
			 Benefits: Illustrative List of the Largest Three Small Group Products by
			 State." These bulletins are the Secretary's implementation of Section 1302(b)
			 of the Affordable Care Act.
Under the December 16, 2011 HHS bulletin, HHS requires that
			 states choose in the third quarter of 2012 one of the following benchmark
			 health insurance plans to serve as a reference for providing EHB in
			 non-grandfathered health plans:
(1)
		  the largest plan by enrollment in any of the three largest small group
		  insurance products in the State's small group market;
(2) any of the largest three State employee
		  health benefit plans by enrollment;
(3) any of the largest three national FEHBP
		  plan options by enrollment; or
(4)
		  the largest insured commercial non-Medicaid Health Maintenance Organization
		  (HMO) operating in the State. HHS further provides that if a state does not
		  exercise its option to select a benchmark health plan, the default benchmark
		  health plan for that state is the largest plan by enrollment in the largest
		  product in the state's small group market.
The purpose of this Rule is to provide guidance for selecting the
			 benchmark plan for establishing EHB for non-grandfathered health plans offered
			 through the Exchange operating in the State as well as for non-grandfathered
			 plans offered in the individual and small group markets outside the Exchange in
			 the State. In addition, this Rule shall define the criteria or standards which
			 are the basis for the selection of the benchmark health plan.