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Essential Health Benefits “Benchmark Plan” Selected for 2017

Thursday, July 2, 2015

A benchmark plan determines which health insurance benefits are required by law for all individual and small group plans sold in the District of Columbia

Washington, D.C. – Today, the D.C. Department of Insurance, Securities and Banking (DISB) and the D.C. Health Benefit Exchange Authority (HBX) announce the 2014 Group Hospitalization and Medical Services, Inc. (GHMSI) (CareFirst BlueCross BlueShield) BluePreferred PPO $1,000 – 100/80% Plan as the “benchmark plan” selection for plans sold in the District of Columbia starting in 2017.

A benchmark plan determines which health insurance benefits are considered essential under the federal Patient Protection and Affordable Care Act, and therefore required of all plans sold to small businesses and to individuals and families.

"This benchmark plan selection continues DISB’s and the D.C. Health Benefit Exchange Authority’s commitment to ensuring that residents have access to all essential health benefits required under the law and that our residents and businesses are a part of important policy decisions impacting their health and that of their families and employees,” said DISB Acting Commissioner Stephen C. Taylor.

The HBX Executive Board requested its Standing Advisory Board analyze options for the essential health benefits benchmark and to recommend the best option for the District. After a comprehensive review of benefits and formularies, and discussion of public written and oral comments, the HBX Standing Advisory Board voted unanimously to select the 2014 GHMSI BluePreferred PPO Plan. The HBX Executive Board then voted unanimously to approve this benchmark plan selection. Commissioner Taylor today notified the Center for Consumer Information and Insurance Oversight of the District’s benchmark plan selection as required by the Centers for Medicare & Medicaid Services.

“Despite the short time to make a decision, the Standing Advisory Board spent significant time thoroughly analyzing all options through a review of benefits and exclusions, reviewing HBX staff and DISB staff research, and considering public input,” said Diane C. Lewis, chair of the HBX Executive Board.

The selection is consistent with the District’s previous benchmark selection for plans sold from 2014-2016. The GHMSI BluePreferred PPO plan was the largest small group health plan sold in the District based on enrollment in first quarter 2014.

More information on essential health benefits and District’s process for selecting the benchmark plan can be viewed here.