HHS Announces The Final Rule for ACA Deductibles and Essential Benefits

The Department of Health and Human Services (HHS) Announces the Final Rule for Affordable Care Act (ACA) Deductibles and Essential Benefits.

On February 20, 2013, the Department of Health and Human Services (HHS) released a final rule that provides guidance for health insurance markets. "The Affordable Care Act helps people get the health insurance they need," said Secretary Sebelius. "People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits."

As stated in previous HHS guidance, the health care law has directed that all types of health insurance (including self-insurance) will include an annual limit on out-of-pocket cost sharing for individuals and families in 2014. Before now, self-insured plans such as Health Savings Accounts (HSAs) and Other Tax-Favored Health Plans had limits on out-of-pocket cost sharing. The 2013 out-of-pocket limits for HSAs are $6,250 for self-only coverage and $12,500 for family coverage. While HHS has not determined the limits for 2014, additional HHS guidance is expected for the application of this policy to the group market soon.

The new rule also outlines health insurance standards for a core package of benefits, called essential health benefits that health insurers must cover. The standards in the final rule also expand coverage of mental health and substance use disorder services, including behavioral health treatment.

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