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Essential Health Benefit Benchmark Plan for 2017

Information on 2017 Benchmark Plans for all states is available by clicking here. 

 

One of the goals of the Affordable Care Act (ACA) is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits (EHB). The ACA provides that EHB’s include items and services within at least the following 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; and pediatric services, including oral and vision care (See 42 USC §18022).

 

For plans sold in calendar years 2017, the U.S. Department of Health and Human Services (HHS) has provided Kentucky with the flexibility to recommend its EHBs from 10 benchmark plans which HHS has determined reflect the scope of services offered by a “typical employer plan” in the first quarter of 2014. This approach will give the Commonwealth the flexibility to select a plan that would best meet the needs of Kentuckians. (See, 45 CFR 156.110) 

 

Additional guidance on the 2017 benchmark recommendation was issued on April 8, 2015.  States must submit recommendations for their benchmark plan to HHS by June 1, 2015.  Kentucky has requested and received an extension until July 1, 2015 to submit its recommendation. In accordance with the guidance and regulations from HHS, Kentucky will recommend its essential health benefits using one of the following benchmark health insurance plans:

 

Three largest small group plans in Kentucky by enrollment:

Three largest state employee health plans by enrollment:

Three largest federal employee health plan options by enrollment:

The largest HMO plan offered in the state’s commercial market by enrollment:

Enrollment information is currently being analyzed to determine the plan that meets this benchmark option.

 

Additionally, Kentucky may look to the largest Federal Employees Dental and Vision Insurance Program (FEDVIP), and the state Children’s Health Insurance Program (CHIP) in order to supplement benefits for pediatric oral and vision benefits. Here are links to those plans: