DC- Essential Health Benefits “Benchmark Plan” Selected for 2017

The ACA requires state health insurance exchanges to offer four types of healthcare plans: bronzesilvergold, and platinum. Bronze is the least comprehensive plan in terms of services covered and often least expensive; the platinum plan is the most extensive and often most expensive.

The second-lowest priced silver plan available within a state health insurance exchange in a geographical region is called the “benchmark plan”.  Available premium credits (subsidies) are calculated based upon the cost of the benchmark plan and adjusted according to an applicable enrollee’s annual income.

Yesterday, the D.C. Department of Insurance, Securities and Banking (DISB) and the D.C. Health Benefit Exchange Authority (HBX) announced the 2014 Group Hospitalization and Medical Services, Inc. (GHMSI) (CareFirst BlueCross BlueShield) BluePreferred PPO $1,000 – 100/80% Plan as the “benchmark plan” selection for plans sold in the District of Columbia starting in 2017.

In a joint press release distributed by D.C. Department of Insurance, Securities and Banking and D.C. Health Benefit Exchange Authority they stated:

“This benchmark plan selection continues DISB’s and the D.C. Health Benefit Exchange Authority’s commitment to ensuring that residents have access to all essential health benefits required under the law and that our residents and businesses are a part of important policy decisions impacting their health and that of their families and employees,” said DISB Acting Commissioner Stephen C. Taylor.

The HBX Executive Board requested its Standing Advisory Board analyze options for the essential health benefits benchmark and to recommend the best option for the District. After a comprehensive review of benefits and formularies, and discussion of public written and oral comments, the HBX Standing Advisory Board voted unanimously to select the 2014 GHMSI BluePreferred PPO Plan. The HBX Executive Board then voted unanimously to approve this benchmark plan selection. Commissioner Taylor today notified the Center for Consumer Information and Insurance Oversight of the District’s benchmark plan selection as required by the Centers for Medicare & Medicaid Services.

“Despite the short time to make a decision, the Standing Advisory Board spent significant time thoroughly analyzing all options through a review of benefits and exclusions, reviewing HBX staff and DISB staff research, and considering public input,” said Diane C. Lewis, chair of the HBX Executive Board.

The selection is consistent with the District’s previous benchmark selection for plans sold from 2014-2016. The GHMSI BluePreferred PPO plan was the largest small group health plan sold in the District based on enrollment in first quarter 2014.”

For more information regarding essential health benefits and the District’s process for selecting the benchmark plan ,visit : http://disb.dc.gov/node/1067142 .

Early, Cassidy and Schilling, Inc. is aware that many of our clients will be affected by this and we are here to help guide you through it.  Any questions give us a call at 301-948-5800.

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