It’s time to weigh in on New York’s "Essential Health Benefits"!

Posted August, 13 2012 by arianne

As part of the ACA, New York State’s Exchange has to select a health insurance benefit package to serve as the State’s “Essential Health Benefits” (EHB).   These will be the core health benefits that will be required to be covered by all (non-grandfathered) health plans sold in New York starting in 2014.

According to federal regulations, New York has to select one of ten existing plans as the basis for the EHB. The options include 3 Oxford small group plans, 3 state employee benefits plans, 3 federal employee benefit plans, and one HMO.

The State has contracted with Milliman to do a study of the various options, and Milliman presented the results at a Stakeholder meeting in Albany on August 2.  You can find the powerpoint presentation Milliman prepared for that meeting, and some spreadsheets comparing the different plans (Exhibits) on the State’s Federal Health Care Reform website:

Based on the available options, HCFANY recommends that the State select the New York State Employee Plans’ Empire Plan for New York’s EHB benchmark plan. Of all the choices, this plan offers the most comprehensive benefits.

Got an opinon on this? Well, the Exchange has asked stakeholders to send in comments on the EHB decision by this Friday, August 17.  We have prepared a template letter that you can use.  Simpy fill in the blanks about what benefits you,  your community, or members of your organization need to have covered by the EHB benchmark. If possible, explain how it would affect you if the EHB does not cover the benefits you need.  Comments can be submitted to

Lastly, if you do choose to send in comments on this, feel free to send us a copy so we can be sure that our future advocacy reflects the needs of consumers like you.

Click here to read HCFANY’s comments to the NYS Exchange on the Essential Health Benefit Benchmark Plan options

Click here to view HCFANY’s template letter on the NYS Essential Health Benefit Benchmark Plan options