30 Second Insurance Tips©

Tip 100- Essential Benefits

Recently the Department of Health & Human Services released regulations providing clarity to
the minimum levels of coverage ‐ the “Essential Benefits” ‐ that will be required for health
plans to be compliant with The Affordable Care Act.

Among other things, these regs dictate that deductibles can be no higher than $2,000; that out
of pocket maximums may not exceed $6,250; and, that pediatric dental and vision coverage will
be included as a part of the core health plan.

Actuaries predict these new mandates will add substantial additional premium on top of
normal trends.

On a group by group basis, it may make sense to renew coverage in 2013 for a short plan year.
For example, a group with an April 1 anniversary date might reapply for coverage October 1st,
thus putting off until October 1, 2014 the increased cost of insuring “Essential Benefits.”