SCC Bureau of Insurance Seeks Public Comments Regarding Essential Health Benefits Benchmark Plan

RICHMOND – The State Corporation Commission’s (SCC) Bureau of Insurance (Bureau) is seeking public comments regarding Virginia’s proposed essential health benefits (EHB) benchmark plan application for plan year 2025. The final application is due to the Centers for Medicare & Medicaid Services (CMS) by May 3, 2023.

Legislation passed by the 2023 Virginia General Assembly directs the Bureau to select a new EHB benchmark plan for plan year 2025. The EHB benchmark plan sets the required benefits that must be provided by comprehensive fully-insured individual and small group health insurance coverage issued in Virginia. Before Virginia adopts the new EHB benchmark plan, the Bureau must release the plan for public comment and then obtain approval of the plan from CMS.

In 2022, the General Assembly directed the Bureau to study and analyze the Commonwealth’s options for a new EHB benchmark plan for potential implementation in 2025 and to report its findings. The SCC utilized federal grant money to review Virginia’s EHB benchmark plan to present potential updates, including additional health benefit options. As part of this process, a consulting actuary for the Bureau also provided cost estimates of additional health benefits recently considered by Virginia’s Health Insurance Reform Commission and compared Virginia’s EHB benchmark plan to those of several other states.

Among the potential benefits studied for inclusion in Virginia’s 2025 EHB benchmark plan were medically necessary prosthetic devices and components as well as formula and enteral nutrition products as medicine. The recently-passed 2023 legislation directs the Bureau to add these benefits to the EHB benchmark plan in addition to the current benefits. Following public comment, the proposed 2025 EHB benchmark plan application must be approved by CMS in advance. A CMS determination on Virginia’s proposed 2025 EHB benchmark plan is expected by late summer 2023.

In addition to the legislation regarding the 2025 EHB benchmark plan, the 2023 General Assembly passed legislation that would establish a formalized process for future review and updates to Virginia’s EHB benchmark plan.

Public comments on Virginia’s proposed EHB benchmark plan application for plan year 2025 must be submitted to the Bureau of Insurance at: EHBComments@scc.virginia.gov by Wednesday, April 12. Those comments will be published on the Bureau’s website at Virginia SCC - Essential Health Benefits Benchmark Plan.

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Contact: Katha Treanor, 804-371-9141