DIFS Seeks Public Comment on Michigan Essential Health Benefits Benchmark Plan

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DIFS Seeks Public Comment on Michigan Essential Health Benefits Benchmark Plan

Wednesday, May 20, 2015

The Department of Insurance and Financial Services (DIFS) is seeking public comment on the selection of the state’s essential health benefits for 2017. Beginning in 2014, the federal Affordable Care Act required health plans sold in the individual and small group markets to offer a comprehensive package of items and services, known as "essential health benefits." The State of Michigan chose a benchmark plan in 2012 for use in the 2014-2016 plan years. The federal government now requires that all states choose a new benchmark plan, for use in plan year 2017, by July 1, 2015. 

"We welcome public input and encourage anyone with comments to submit them," Director Ann Flood said. 

The state must select one benchmark plan from the following: 

  • One of the three largest small group plans in the state by enrollment; 
  • One of the three largest state employee health plans by enrollment; 
  • One of the three largest federal employee health plan options by enrollment; or 
  • The largest HMO plan offered in the state’s commercial market by enrollment. 

Essential health benefits must include items and services within the following 10 categories: 

  • Ambulatory patient services; 
  • Emergency services; 
  • Hospitalization; 
  • Maternity and newborn care; 
  • Mental health and substance use disorder services, including behavioral health treatment; 
  • Prescription drugs; 
  • Rehabilitative and habilitative services and devices; 
  • Laboratory services; 
  • Preventive and wellness services and chronic disease management; and 
  • Pediatric services, including oral and vision care. 

Additional information and a comparison of the essential health benefits benchmark plans being considered for 2017 are available online. 

Public comments will be accepted through June 5, 2015 and should be sent electronically to DIFS-EHBcomments@michigan.gov.