A major requirement of the Affordable Care Act is that most fully-insured individual and small group health insurance plans must offer a comprehensive set of benefits called "essential health benefits" (EHBs).  The requirement applies whether the plans are sold through the health insurance exchanges that will be set up in 2014 or outside of the exchanges.  Under Department of Health and Human Services regulatory guidance, states have the option of choosing among four types of plans operating in their states as benchmarks for the EHBs.

While states have lagged in setting up their own exchanges, they are moving more quickly to designate EHB benchmarks, according to experts at the National Academy for State Health Policy (NASHP), which held a webinar on EHBs Sept. 24. States have until Sept. 30 to designate an EHB benchmark plan, although that deadline is flexible, NASHP Program Director Sonya Schwartz said.

Eleven states and the District of Columbia have made preliminary decisions regarding their EHB benchmarks, and all of them except Utah have designated their states' largest small group plans, according to Chris Cantrell, a policy analyst with NASHP. Their decision "suggests that states are choosing the option that would minimize disruption to their insurance market and limit the possibility that they'll have to pay extra costs for benefits that exceed the EHB requirement," he said. Utah designated a state employee plan.