Filed Under:Health Insurance, Individual Health

New Hampshire to base PPACA benchmark on WellPoint plan

The New Hampshire Statehouse (AP Photo: Jim Cole)
The New Hampshire Statehouse (AP Photo: Jim Cole)

New Hampshire officials have picked the Matthew Thornton Blue small group plan to be the state's essential health benefits (EHB) benchmark plan.

State Rep. John Hunt, the chairman of the state's Joint Health Care Reform Oversight Committee, has written to U.S. Health and Human Services Secretary Kathleen Sebelius to announce the state's EHB benchmark selection.

Officials in some states have said they are not really sure how seriously Sebelius will take states' EHB choices when making the final EHB selections.

In the letter to Sebelius, Hunt, R-Cheshire, N.H., acknowledged that Section 1302(b) of the Patient Protection and Affordable Care Act of 2010 (PPACA) gives Sebelius the authority to define each state's EHB package.

"I understand that the selected plan will serve as a 'reference plan' in defining the scope of services that will be considered essential health benefits in New Hampshire for calendar years 2014 and 2015," Hunt wrote in the letter.

EHB benchmark picks were due at HHS Sunday.

In some states, questions about EHB coverage mandates for children with autism and other people with developmental disabilities have dominated the EHB debates.

In New Hampshire, the state-regulated EHB candidate plans already provide coverage for early intervention therapy services for children.

The EHB package

PPACA opponents continue to fight the law in the courts, in Congress, in state legislatures and at the polls

If the law takes effect on schedule and works as drafters expect, it will require all individual and small group major medical plans to offer the standardized EHB package by 2014, in an effort to help consumers compare plans on an apples-to-apples basis.

HHS has asked each state to design its own EHB package.

A state is supposed to start by looking at the benefits offered by the three largest Federal Employee Health Benefits Program plans offered in the state, the three largest state employee benefit plans, the three largest small group commercial health plans, and the largest commercial health maintenance organization (HMO) plan.

The EHB benchmark plan chosen must provide benefits in 10 different areas, including ambulatory patient services, emergency services, hospitalization services and pediatric oral and vision health services.

HHS has been telling states to keep solid, affordable small group plans in mind, rather than deluxe benefit plans, when developing the EHB benchmarks.

In states that fail to develop EHB benchmarks, HHS is supposed to choose the benchmark plan, according to PPACA.

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