Beginning in 2014, individual and small group health plans will be required to offer a standardized benefit package (Essential Health Benefits) based upon a benchmark plan that includes
10 categories required by the ACA. In December 2011, the Center for Consumer Information and Insurance Oversight (CCIIO) issued
guidance for states around selecting a benchmark plan. This benchmark plan will be used for two years, and the federal government will determine what the benchmark plan will be beginning in 2016.
The CCIIO guidance outlined a
process by which states were asked to select a benchmark plan from a set of existing health plans already in states’ insurance markets and to submit a recommendation for the selected plan to CCIIO by the third quarter of 2012. However, the federal government has stated it will continue to work with states that do not make their selection by the requested date.
Even with flexibility from the federal government on the submission deadline, states are working hard internally and with stakeholders to submit Essential Health Benefits (EHB) recommendations to CCIIO by September 30. Regardless of the federal deadline, it is critical for states to select an EHB in order to give their health plans sufficient time to develop products and premium rates to submit to state insurance agencies for approval to be ready for sale through insurance exchanges on October 1, 2013.
Recent Stakeholder Engagement
Illinois,
New Hampshire, and
Washington, D.C. have held public meetings to discuss their state’s EHB options with interested stakeholders and to put those options out for public comment.
New York’s exchange regional advisory committees are taking feedback from across the state on its EHB options. The regional advisory committees consist of 175 people representing various stakeholders.
Preliminary Recommendations
After extensive stakeholder engagement and outreach,
Colorado’s Governor’s Office, the Department of Insurance, and the Colorado Health Benefit Exchange issued a
preliminary recommendation that Kaiser Permanente—Colorado's largest small‐group health insurance plan—serve as the Essential Health Benefits benchmark plan.
The
Delaware Health Care Commission has
recommended, based on stakeholder feedback, that the state select the Blue Cross Blue Shield Small Group EPO plan as the state's Essential Health Benefits benchmark plan, which will be supplemented with other services once CCIIO issues additional guidance on supplement options.
On August 14, 2012, the
Oregon Health Authority Board and the Oregon Health Insurance Exchange Corporation Board
presented their process and recommendation for selecting Oregon’s third largest small group plan, PacificSource Preferred Small Group, as the Essential Health Benefits benchmark plan.
Rhode Island’s exchange board recently reviewed the EHB recommendations.
Utah’s Legislative Health Reform Task Force unanimously decided to recommend the Public Employee Health Plan’s (PEHP) Basic Plus plan as the state’s Essential Health Benefits benchmark plan. According to the
Salt Lake Tribune, the Task Force recommendation is not binding but will go to the Utah Insurance Commissioner for decision-making and issuance of emergency rules.
