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:
- 2025 Final EHB Benchmark Plan Application for Virginia (changes from the draft application included some updates to preventive care services and more detail on pediatric dental services)
- AppA-StateConfirm-Template-508 final
- VA Appendix B
- Virginia EHB-BP Update PY2025 - Actuarial Report and Certification 3.9.2023
- AppC-EHB-Benefits-Limits-508 final
- VACMS-10448-Appendix D EHB BM Plans-Rx Template-090919
- Benefits for Health Care Coverage Benchmark final
- BMP Summary-VA-Updated-2025 public final
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: ACAFilingInfo@scc.virginia.gov
Links
- Virginia’s EHB Benchmark Plan
- Review and Evaluation of Potential Changes to Virginia’s EHB Benchmark Plan
- HB 2198/SB 1399 (Bills directing SCC Bureau of Insurance to select a new EHB Benchmark Plan for Plan Year 2025 that includes, the current EHB package, as well as coverage for enhanced prosthetic devices and formula and enteral nutrition products for inherited metabolic disorders as medicine.)
- HB 2199/SB 1397 (Bills establishing the process for reviewing Virginia’s EHB Benchmark Plan on an ongoing basis)
- News Release Requesting Input on EHB
- News Release Announcing Virginia’s EHB Benchmark Plan Approval
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.