CCIIO Designates Benchmark Plans

The Center for Consumer Information and Insurance Oversight (CCIIO) has announced the designation of health insurance plans that states may use as benchmarks to determine whether health plans offered provide the essential health benefits (EHB) required by Patient Protection and Affordable Care Act (ACA) Sec. 1302(b). The CCIIO identified: (1) the three largest small group health plans in each state, as measured by enrollment during the first calendar quarter of 2014; (2) the three largest plans offered to federal employees nationwide under the Federal Employees Health Benefits Program; and (3) the federal dental and vision plans with the largest enrollment during the first quarter of 2014.

Other options for benchmark plans. In addition to the first two items listed above, states may select as the benchmark benefits plan: (1) any of the three health benefit plans available to state employees with the largest enrollment; or (2) the largest insured commercial, non-Medicaid health maintenance organization (HMO) in the state.

Available information. The list includes small group products that are open for enrollment and products that are closed to new enrollees but still approved for sale. States may have more recent enrollment information than CCIIO’s; if their information shows that a small group plan not on the CCIIO list is one of the three with the largest enrollment, they should notify the CCIIO. States also are reminded that qualified health plans must cover all ten of the EHBs listed in Sec. 1302. If a state wishes to designate as benchmark a plan that does not cover an EHB, it must supplement the coverage to provide the benefit.

For more information, visit http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/largest-smgroup-products-4-8-15-508d-pdf-Adobe-Acrobat-Pro.pdf.

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