WASHINGTON — The Obama administration took a big step Tuesday to carry out the new health care law by defining "essential health benefits" that must be offered to most Americans and by allowing employers to offer much bigger financial rewards to employees who quit smoking or adopt other healthy behaviors.
The proposed rules, issued more than 2 1/2 years after President Barack Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign.
Insurance companies are rushing to devise health benefit plans that comply with the federal standards. Starting in October, people can enroll in the new plans for coverage that begins Jan. 1, 2014.
The rules translate the broad promises of the 2010 law into standards that can be enforced by state and federal officials. Under the rules, insurers cannot deny coverage or charge higher premiums to people because they are sick or have been ill. They also cannot charge women more than men, as many now do.
"Thanks to the health care law, no one will be discriminated against because of a pre-existing condition," said Kathleen Sebelius, the secretary of health and human services, who issued the rules with Phyllis Borzi, an assistant secretary of labor, and Steven Miller, the acting commissioner of the Internal Revenue Service.
The rules lay out 10 broad categories of essential health benefits but allow each state to specify the benefits within those categories, at least for 2014 and 2015. Thus, the required benefits will vary from state to state, contrary to what many members of Congress had assumed when the law was adopted.
Most states are defining essential benefits to be those provided by the largest health plan in the state's small-group insurance market. However, to comply with the law, federal officials said, insurers must provide certain additional benefits, including dental care and vision services for children, treatment of mental health and drug abuse problems, and "habilitative services" for people with conditions like autism or cerebral palsy.
The proposed rules go beyond informal guidance issued by the administration last December, most notably by requiring more comprehensive coverage of prescription drugs.