Essential Health Benefits Benchmark Plan

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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.

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.  All of Virginia’s EHB Benchmark Plans from 2017-2025 can be viewed at this link: Information on Essential Health Benefits (EHB) Benchmark Plans | CMS

Please send questions to:


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:

Next Steps

  • Prior to 2025, the Bureau will convene a workgroup of relevant stakeholders to consider potential recommended changes to the EHB benchmark plan that will be included in the workgroup recommendations for HIRC by March 31, 2025.