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Adoption of Essential Health Benchmarks as of December 2012

Each state is required to choose from a range of existing and popular (number of enrollees) health plans and use that plan as an Essential Health Benefit (EHB) benchmark. It is proposed that states without a benchmark plan selected by 12/26/12, will default to the small group plan with the largest enrollment in the state. Insurers will have to offer plans with substantially equal benefits to those found in a state's benchmark plan. The EHB benchmark only defines what benefits must be covered, not the cost sharing. The ACA (Affordable Care Act) explains the different levels of plans (bronze, silver, gold and platinum) and insurers will develop pricing and cost sharing features based on the actuarial values of each of the plan levels.

States with benchmark plans that do not include all the required EHBs will identity supplemental coverage to bring the plans into compliance. For rehabilitative services states must define the benefits, or insurers must provide comparable benefits and report them to HHS. The pediatric vision and dental services that have been proposed will require almost all states to provide supplements to the benchmark plans. It is proposed that states use the Federal Employees Dental and Vision Insurance Program or Children's Health Insurance Program for guidance.

As of December 2012 the following selections have been made:

Small group plans:

AR, CA, CO, DE, DC, HI, IL, KS, KY, MA, MS, NV, NH, NM, NY, NC, OR, RI, VA, WA

State Employee Plans:

AZ, MD, UT

HMO Plans:

CT, MI, ND, VT

Default Plans (small group health plan with the largest enrollment in the state):

AL, AK, FL,GA, ID, IN, IA, LA, ME, MN, MO, MT, NE, NJ, OH, OK, PA, SC, SD, TN, TX, WV, WI, WY

 

 

 

 

 

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