Smart Benefits: Feedback on Next Essential Health Benefits Benchmark Plan Due June 30

Monday, June 29, 2015
Rob Calise, GoLocalWorcester Business/Health Expert

The ACA requires health plans sold in the individual and small group markets to offer a package of items and services, known as “essential health benefits.” To meet the requirement, states choose a benchmark plan to establish the services and items included in their essential health benefits package. In 2012, Rhode Island chose Blue Cross Blue Shield’s Vantage Blue plan as its benchmark plan for the 2014-2016 plan years. But now it’s time for states to select a new benchmark plan for use in plan year 2017, and Rhode Island’s Office of the Health Insurance Commissioner (OHIC) is accepting comments on the selection of essential health until tomorrow. 

The essential health benefits must include items and services from 10 categories:

•    Ambulatory patient services;
•    Emergency services
•    Hospitalization
•    Maternity and newborn care
•    Mental health and substance use disorder services, including behavioral health treatment
•    Prescription drugs
•    Rehabilitative and habilitative services and devices
•    Laboratory services
•    Preventive and wellness services and chronic disease management
•    Pediatric services, including oral and vision care

According to the selection process, each state must choose one benchmark plan from the following: 

•    One of the three largest small group plans in the state by enrollment
•    One of the three largest state employee health plans by enrollment
•    One of the three largest federal employee health plan options by enrollment 
•    The largest HMO plan offered in the state’s commercial market by enrollment

After initial review, OHIC has narrowed the options down to the largest plan in any of the three largest small group products. The top small employer plans by enrollment in Rhode Island, as published by the Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services, are: 

•    UnitedHealthcare Choice Plus
•    VantageBlue w/Rx
•    BlueSolutions for HSA w/Rx

A comparison chart of the three options can be found here. 

As a part of its review EHB benchmark plan options, OHIC is soliciting public comment. All public comments must be received by OHIC by June 30, 2015.

Rob Calise is a founding partner of Cornerstone Group, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.

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