A new law (SSB 5338 (leg.wa.gov) directs the Office of the Insurance Commissioner (OIC) to review Washington state’s Essential Health Benefits (EHB) benchmark health plan and decide whether or not to ask the federal government for approval to update the plan. The OIC must report its findings and decision to the legislature by Dec. 31, 2023,
Defining Washington state’s EHB-benchmark health plan
The Affordable Care Act requires certain benefits, items and services be covered by all individual and small employer health plans. These are called Essential Health Benefits. Each state must select its own “benchmark” health insurance plan and use it to determine its essential health benefits. Since 2020, Washington state’s EHB benchmark plan has been the Regence BlueShield Direct Gold+ small group health plan.
Beginning in 2020, the Centers for Medicare and Medicaid Services (CMS) gives states three options to define their EHB benchmark plan:
- Option 1: Select another state’s entire EHB benchmark,
- Option 2: Replace a category of benefits in the current benchmark with the same category of benefits used in another state's EHB plan, or
- Option 3: Select a set of benefits to become part of the your state's EHB plan.
States that want to make changes are required by Federal law (ecfr.gov) to have an actuarial analysis of the benefits, a public comment on the proposed changes, and apply to CMS.
How to get involved
- Submit your comments to the rules coordinator.
- Subscribe to get updates via email or text alerts about the EHB-benchmark plan (govdelivery.com).
Sept. 12, 2023
June 12, 2023
State and federal EHB information
- EHB statute: RCW 48.43.715 (leg.wa.gov)
- EHB rules: WAC 284-43-5602, WAC 284-43-5622 and WAC 284-43-5642 (leg.wa.gov)
- SSB 5338 (leg.wa.gov)
- Information on EHB-benchmark plans (cms.gov)
- 45 CFR 156.111 State EHB-benchmark plan update federal rule (www.ecfr.gov)
- Commonwealth Fund article “HHS considers updating the essential health benefits” (www.commonwealthfund.org)
- CMS and HHS EHB request for information (govinfo.gov)