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State of Idaho
700 West State Street, 3rd Floor
P.O. Box 83720
Boise, Idaho 83720-0043
Phone (208)334-4250
Fax (208)334-4398



June 12, 2013
CONTACT: Tricia Carney
cell 208-850-2342
Essential Health Benefits of the Affordable Care Act

BOISE ID (June 12, 2013) – The Idaho Department of Insurance encourages consumers to understand the Affordable Care Act (ACA) and how this law will affect them. An important change that will take effect January 1, 2014, is the implementation of Essential Health Benefits (EHBs) in health insurance policies.

“Most Idahoans will be impacted by the ACA in some way,” says Department Director Bill Deal. “We will all have to understand some new terms and how they apply to our different situations.”

The United States Department of Health and Human Services issued the final rule regarding EHBs. Starting in January 2014, health insurance plans in the individual and small group markets, both inside and outside of health insurance exchanges must offer a core package of items and services within at least the following ten 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
  • Pediatric services, including oral and vision care

EHBs must be covered with no annual dollar limits or lifetime maximums and must be included in nongrandfathered individual and small employer plans as they renew in 2014. Individual or small employer group policies that were issued prior to March 23, 2010, may be grandfathered, meaning they would not have to comply with all of the new requirements in the ACA. You should contact your carrier about specific coverage in your existing policy.

The EHB requirement is designed to match the benefits offered by typical employer plans within each state. More detailed information about Idaho’s Benchmark Plan is available on the Department’s website.

The Department of Insurance encourages Idaho citizens to visit the website, www.doi.idaho.gov, to learn more about the ACA and to keep abreast of upcoming changes. Consumers may call the Department, 334-4250 in the Boise area or 800-721-3272 toll-free statewide.

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About the Department of Insurance
The Idaho Department of Insurance has been regulating the business of insurance in Idaho since 1901. The mission of the Department is to equitably, effectively and efficiently administer the Idaho Insurance Code and the International Fire Code. For more information, visit www.doi.idaho.gov.