Under the ACA, certain insurance plans, including those participating in new purchasing exchanges, must cover, at a minimum, a package of items and services that the Secretary has defined as essential. The Institute of Medicine (IOM) has released recommendations to HHS on a process to define what benefits should be included in the “essential health benefits” (EHB) package under the ACA. Note that the IOM has not weighed in on specific benefits to be covered in the EHB, but rather it proposes a set of criteria and methods that should be used in deciding what benefits are most important for coverage. According to the report, the IOM “committee saw its primary task as finding the right balance between making a breadth of coverage available for individuals at a cost they could afford.” For instance, criteria to guide content of the aggregate EHB package include: ensuring that the package is affordable for consumers, employers, and taxpayers; maximizing the number of people with insurance coverage; addressing the needs of the most vulnerable patients and populations; promoting the right care to the right patient in the right setting at the right time; focusing on high value services; addressing the medical concerns of greatest importance to enrollees as identified through a public deliberative process; and protecting against the greatest financial risks due to catastrophic events or illnesses. With regard to specific components of the EHB package, the individual service, device, drug generally must: be safe, with expected benefits greater than expected harms; be medically effective and supported by a sufficient evidence base or credible standard of care; demonstrate meaningful improvement in outcomes over current effective services/treatments; be a medical service; and be cost effective. The IOM notes that failure to meet any of these criteria should result in exclusion or significant limits on coverage, and inclusion does not mean that an item or service is appropriate for every person. The IOM also sets forth criteria for defining updating the EHB package, focusing on the use of a transparent, participatory, equitable, and consistent process that is sensitive to the value of services, responsive to new information, cognizant of budget constraints, encouraging to innovation, and data-driven.