NOTICES
INSURANCE DEPARTMENT
Commonwealth Essential Health Benefits Benchmark Plan—Public Comment Period; Notice 2023-14
[53 Pa.B. 4072]
[Saturday, July 29, 2023]The Insurance Department (Department) is exploring the possibility of updating the Commonwealth's Essential Health Benefits benchmark plan (EHB-benchmark plan), including the positive impacts an update may have on Commonwealth residents enrolled in individual and small group health insurance plans. The Department seeks public input about which benefits to potentially include in an updated EHB-benchmark plan as the Commonwealth considers this important update process. The Commonwealth's current EHB-benchmark plan can be found at https://www.cms.gov/cciio/resources/data-resources/ehb#Pennsylvania.
Under the Affordable Care Act (P.L. 111-148), the EHB-benchmark plan establishes the minimum essential health benefits that individual and small group health insurance plans must offer. The Commonwealth's EHB-benchmark plan must provide coverage for at least the following benefit categories:
1. Ambulatory patient services.
2. Emergency services.
3. Hospitalization.
4. Maternity and newborn care.
5. Mental health and substance use disorder services, including behavioral health treatment.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices.
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services, including oral and vision care.
In addition to the required coverage categories, Federal regulations provide parameters that must be considered prior to updating the EHB-benchmark plan:
• The scope of benefits must be equal to, or greater than, the scope of benefits provided under a typical employer plan.
• The EHB-benchmark plan's generosity may not exceed certain comparison plans from 2017, including the EHB-benchmark plan used in 2017. Generosity in this case refers to the actuarial value of the benefits provided—how much financial coverage the EHB-benchmark plan offers for covered services.
• The EHB-benchmark plan's benefits must not be unduly weighted toward any of the benefit categories previously listed.
• The EHB-benchmark plan must provide benefits for diverse segments of the population, including women, children, persons with disabilities and other groups.
• The EHB-benchmark plan must not include discriminatory benefit designs.
To assist the Department in evaluating options for an updated EHB-benchmark plan, the Department seeks public input about what benefits an updated EHB-benchmark plan should include so that Commonwealth residents continue to have access to comprehensive coverage that is consistent with current medical practices.
Comments may be directed to Katie Merritt, Director of Policy and Planning, Office of the Insurance Commissioner, 1326 Strawberry Square, Harrisburg, PA 17120. Comments may also be e-mailed to ra-in-policyoffice@ pa.gov. Comments must be submitted by September 1, 2023, for consideration. The Department appreciates public engagement with this process as the Department seeks to improve health care coverage in this Commonwealth.
MICHAEL HUMPHREYS,
Insurance Commissioner
[Pa.B. Doc. No. 23-1017. Filed for public inspection July 28, 2023, 9:00 a.m.]
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