Filed Under:Health Insurance, Individual Health

CMS: Essential Health Benefits Benchmark Picks Due Sept. 30

States should try to choose essential health benefits (EHB) benchmark plans by the end of the third quarter.

Officials at the Centers for Medicare & Medicaid Services (CMS) have given that advice in a new batch of answers to frequently asked questions posted on the CMS website.

CMS and its parent, the U.S. Department of Health and Human Services (HHS), are developing EHB guidelines to implement the EHB section of the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA calls for health plans to offer a standardized EHB package by 2014 in an effort to help consumers compare health plans on an apples-to-apples basis.

HHS officials reported in December 2011 that they are thinking of letting each state create its own EHB package by using local benchmark plans, such as state government health plans or popular small group health plans.

A state will probably use the same EHB benchmark plans for both 2014 and 2015, but HHS may tinker with the selection process for 2016, officials say.

HHS wants states to use the same benchmark plans for the individual and small group markets.

HHS officials want to include the preventive care benefits already required by PPACA and the new federal mental health parity benefits in the EHB package.

The EHB package requirement will not apply to self-insured group health plans, large group plans, or grandfathered group plans.

PPACA itself requires EHB packages to include some benefits not typically included in today’s health insurance plans, such as pediatric dental services and pediatric vision testing services.

“For pediatric oral care, we are considering proposing that the state would supplement the benchmark plan with benefits from either the Federal Employees Dental and Vision Insurance Program (FEDVIP) dental plan with the largest national enrollment or the state’s separate Children’s Health Insurance Program (CHIP),” officials say. “For pediatric vision care, we are considering proposing that the state would supplement the benchmark plan with the benefits covered in the FEDVIP vision plan with the highest enrollment.”

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Nichole Morford

Nichole Morford
Managing Editor

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