The federal government is letting states choose a different essential health benefits (EHB) benchmark plan for 2017, and this news may re-ignite public debate about what types of services health insurance should cover in plans sold pursuant to the Affordable Care Act, LifeHealthPRO reported.
Benchmark plans must cover at least 10 general categories of essential healthcare items and services to mirror the scope of benefits available through a typical, employer-sponsored insurance plan. Part of the controversy with these services is that the healthcare reform law lets states interpret what belongs in the 10 categories of essential benefits, FierceHealthPayer previously reported. For instance, though benefit requirements include preventive services, different insurer interpretations of this provision have caused confusion about exactly what must be covered.
In 2011, the Centers for Medicare & Medicaid Services asked the states and the District of Columbia to select an EHB benchmark plan voluntarily. Benchmark plans can come from a number of categories: They can be one of the three largest small group plans in the state; any of the three largest plans offered to state workers; any of the three largest Federal Employees Health Benefits Program products; or a state's largest, fully-insured commercial HMO plan, LifeHealthPRO noted.
For the 2017 plan year, CMS has made it administratively simpler for states to choose an EHB benchmark plan, according to an agency statement. Instead of creating a new reporting obligation with a separate form to fill out, states can send CMS an email with a plan's data form filing previously submitted to the state regulator. CMS estimates that states can meet this requirement in about 30 minutes.
When 25 states declined to choose a benchmark plan in 2011, CMS picked the plan for them. The default benchmark plan is largest plan by enrollment in the largest product by enrollment in the state's small group market segment.
- here's the LifeHealthPRO article
- read the CMS Supporting Statement for Essential Benefits Benchmark Plans (.pdf)