Pa., 21 other states default on essential health benefits decision

By - Last modified: January 2, 2013 at 11:38 AM

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Pennsylvania was among the 22 states that did not choose an essential health benefits benchmark plan by the Dec. 26 deadline and defaulted to their largest small-group products.

Generally speaking, the components of the benchmark plan will become the minimum requirement for all nongrandfathered individual and small-group health insurance offerings beginning in 2014. The model is complex, also involving federal requirements, and within certain guidelines plans can substitute different actuarially equivalent coverages.

Pennsylvania’s benchmark will be Aetna Health Inc. PA POS Cost Sharing 34 1500 Ded.

“We also understand that the financial pieces of the coverage options need to be determined as outlined in HHS’ proposed rules, and that those rules are not expected to be finalized until sometime in the early spring,” said Rosanne Placey, spokeswoman for the Pennsylvania Insurance Department.

Small-group products also dominated among 29 states that made selections by the deadline, with 21 choosing them, according to Five states chose their largest HMOs, with only two states choosing a state employee plan and only one state choosing a Federal Employees Health Benefits program.

According to Pennsylvania’s preliminary study of benchmark options, the difference in total cost among the benchmark options was about 1 percent, or about $5 per member per month.