One of the goals of the Affordable Care Act (ACA) is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits (EHB). The ACA provides that EHB’s include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care (See 42 USC §18022).

For plans sold in calendar years 2014 and 2015, the US Department of Health and Human Services (HHS) has provided Kentucky with the flexibility to recommend its EHBs from 10 benchmark plans which HHS has determined reflect the scope of services offered by a “typical employer plan.” This approach will give the Commonwealth the flexibility to select a plan that would best meet the needs of Kentuckians. HHS has issued some guidance regarding this flexibility (See materials dated December 16, 2011, February 17, 2012, and July 2, 2012). In addition, federal regulations regarding data collection for Essential Health Benefits were released in July 2012 (see applicable sections of 45 CFR Part 156). Additional regulations are expected soon.

STATEMENT FROM COMMISSIONER : The Department of Insurance is receiving reports of incorrect information being distributed to the public concerning our position on essential health benefits offered as part of the Kentucky Health Benefit Exchange. Some of this misrepresentation appears to be deliberate. Coverage for elective abortions will not be an essential health benefit. This would be a violation of state law and has never been considered. Under Kentucky law (KRS 304.5-160), health insurance companies cannot offer coverage for elective abortions except as a separate rider with a separate premium. Therefore, abortions cannot be offered as an essential health benefit in Kentucky's Health Benefit Exchange. (8/20/12)