Essential Health Benefits
Benchmark Plan for Opioid Crisis

Your Ideas & Comments

 

Illinois, not unlike other states, is experiencing an unprecedented opioid epidemic with opioid overdoses killing 1,889 people in 2016, an 82% increase over the last three years. The Illinois Department of Insurance (IDOI) is considering whether and how selecting a new EHB-benchmark plan could help address the opioid crisis in our state and invites all individuals who wish to do so to submit written comment regarding possible changes to the Illinois EHB-benchmark plan.

To submit your comments click on the following link:  https://www.surveymonkey.com/r/N9PRYN8.

This public comment period will close 05/29/2018.

The Affordable Care Act (ACA) requires health plans offered in the individual and small group markets, both inside and outside the Illinois Health Insurance Marketplace, to cover a minimum set of medical Essential Health Benefits (EHBs).  EHBs include 10 broad categories of medical benefits that insurers must cover, including: ambulatory care, emergency services, hospitalization, pregnancy, 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. The EHB benchmark plan serves as a baseline for the minimum scope of benefits that most health plans sold in the individual and small group markets must cover at equal or greater value.

The current Illinois EHB-benchmark plan, the BlueCross BlueShield of Illinois “Blue PPO Gold 011” small group plan, supplemented with All Kids pediatric dental package and the federal definition for habilitative services and devices, has served as the Illinois benchmark plan since 2017.  To review the current Illinois EHB-benchmark plan, visit: http://insurance.illinois.gov/HealthInsurance/IllinoisACABenchmarkPlan.pdf

Since the inception of the ACA, federal guidance has allowed each state the opportunity to select from 10 base-benchmark plans: (1) the largest plan by enrollment in any of the three largest products by enrollment in the state’s small group market; (2) any of the largest three state employee health benefit plan options by enrollment; (3) any of the largest three national Federal Employees Health Benefits Program (FEHBP) plan options by enrollment; or (4) the Health Maintenance Organization (HMO) plan with the largest insured commercial non-Medicaid enrollment in the state. Absent a selection by the state, the largest small-group plan has served as the benchmark plan. The Centers for Medicare & Medicaid Services (CMS) is giving states greater flexibility in selecting a benchmark plan by providing three new, additional options.  Illinois can:

  • OPTION 1:  Select an EHB-benchmark plan that another state used for the 2017 plan year;
  • OPTION 2:  Replace one or more categories of EHBs under it EHB-benchmark plan used for the 2017 plan year with the same category or categories of EHB from another state’s EHB-benchmark plan for 2017;
  • OPTION 3:  Select a set of benefits that would become the benchmark plan for Illinois subject to federal guidelines.

 

To learn more about the Plan Year 2020 EHB-Benchmark selection visit:
https://www.cms.gov/cciio/resources/data-resources/ehb.html