Benefit Design

Benefit designs for House Tri-Committee America Affordable health choice act of 2009 (H.R. 3200) create an essential benefits package that provides a comprehensive set of services:
• covers 70% of the actuarial value of the covered benefits,
• limits annual cost-sharing to $5,000/individual and $10,000/family,
• and does not impose annual or lifetime limits on coverage.

The Health Benefits Advisory Council, chaired by the Surgeon General, will make recommendations on specific services to be covered by the essential benefits package as well as cost-sharing levels. [E&L Committee amendment:
• Require early and periodic screening,
• diagnostic,
• and treatment (EPSDT) services for children under age 21 be included in the essential benefits package.]

[E&C Committee amendment: Prohibit abortion coverage from being required as part of the essential benefits package; require segregation of public subsidy funds from private premium payments for plans that choose to cover abortion services beyond Hyde—which allow coverage for abortion services to save the life of the woman and in cases of rape or incest; and require there be no effect on state or federal laws on abortions.]

All qualified health benefits plans, including those offered through the Exchange and those offered outside of the Exchange (except certain grandfathered individual and employer sponsored plans) must provide at least the essential benefits package.

Kaiser, H. (Oct2005). Focus on health reform: Health care reform proposal. Retrieved on Nov. 25, 2009 from http://www.kff.org/healthreform/upload/healthreform_tri_full.pdf


Vangie Yazzie