Essential Health Benefits Benchmark Plan

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Virginia’s Essential Health Benefits (EHB) Benchmark Plan

The Health Insurance Reform Commission (HIRC), in coordination with the Bureau of Insurance (BOI), is directed under § 30-343.1 of the Code of Virginia to conduct a review of Virginia’s Essential Health Benefits benchmark plan every 5 years beginning in 2025.

To support HIRC’s 2025 review of the EHB benchmark plan, BOI convened a workgroup of relevant stakeholders to discuss and make recommendations regarding potential changes that would take effect for plan year 2028.

BOI held monthly meetings from May to August to present to HIRC a report to inform their evaluation of potential benefits to include in a new benchmark plan.  The report will present the workgroup findings, an analysis of proposed benefits, and an assessment of legislation HIRC chose to be considered in the benchmark plan review.

2024 Stakeholder Workgroup Meetings

  • Aug. 22, 2024 1-4 p.m. – Department of Legislative Services Conference Room, General Assembly Building and Hybrid Option
  • July 18, 2024 1-4 p.m. – Department of Legislative Services Conference Room, General Assembly Building and Hybrid Option
  • June 10, 2024 1-4 p.m. – Department of Legislative Services Conference Room, General Assembly Building and Hybrid Option
  • May 23, 2024 1-4 p.m. – Department of Legislative Services Conference Room, General Assembly Building and Hybrid Option

2024 Stakeholder Workgroup Meeting Presentations

Virginia’s Essential Health Benefits (EHB) Benchmark Plan 

The EHB Benchmark Plan is a set of benefits that comprehensive individual and small group health insurance coverage must provide.  Each state determines the EHB Benchmark Plan within guardrails set by federal law.  A state may change its EHB Benchmark Plan.  

During 2022, the General Assembly directed the SCC Bureau of Insurance to study and analyze options for a new EHB Benchmark plan in 2025.  The Bureau, through its consulting actuaries, produced a report that looks at potential changes to Virginia’s EHB Benchmark Plan.  From that report, the Health Insurance Reform Commission (HIRC) decided on the benefits the Bureau should review further for potential inclusion in the 2025 EHB Benchmark Plan. 

Members of HIRC submitted the bills that became law that: 

  • Establish a process whereby Virginia’s EHB Benchmark Plan will be reviewed on an ongoing basis to determine what updates are needed; and 

  • Direct the SCC Bureau of Insurance to continue the application process for a new 2025 EHB Benchmark Plan. 

Links

Public Comments

The Bureau invited public comments on the 2025 EHB Benchmark Plan Draft Application to be submitted from Tuesday, March 28, 2023 through Wednesday, April 12, 2023. The Bureau posts the following submitted comment:

2025 Plan Selection

The following application was submitted for approval to the U.S. Centers for Medicare and Medicaid Services (CMS) for Virginia’s 2025 EHB Benchmark Plan:

CMS approved Virginia’s EHB Benchmark Plan application for Plan Year 2025 on August 28, 2023.  CMS.gov hosts all of Virginia’s EHB Benchmark Plans from 2017-2025