Benchmark Plans and Essential Health Benefits

Beginning in 2014, the Affordable Care Act (ACA) will require health insurance plans for individuals and small groups to cover essential health benefits (EHB). The only plans not required to offer EHB’s are self-funded plans, large group market plans, and grandfathered health plans. However, if they choose to offer EHB’s, there must not be any annual or lifetime dollar limits attached to the service.

The definition of EHB’s does vary depending on the state. Because they differ, each state has put together a specific “benchmark plan” that clearly lays out what they consider to be EHBs. Each self-funded plan will be required to identify a “benchmark plan” that will be used as a reference point for determining which benefits within the plan are EHBs.

As far as your groups are concerned, they may choose any state’s “benchmark plan” regardless of whether they are located in that state or have employees located there. In any case, every EHB plan is prohibited from having any annual or lifetime monetary limits regardless of what state’s “benchmark plan” they choose.

After strong consideration and vigorous research, BPA has chosen to use Utah’s benchmark plan. It allows the greatest flexibility, which will enable you to continue providing your clients with plans that are the right fit for them.  BPA will be using this plan for all of your groups unless you would prefer to us to do otherwise.

BPA encourages you to share this information with your groups in order to provide them with the appropriate education needed in an ever-changing industry. For further information about “benchmark plans” and Essential Health Benefits, go to (Center for Medicare and Medicaid Services) and search for “benchmark plans”. As always, BPA wants to provide you with adequate information so that you can provide the best service to your clients.

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