Each state is required by the Affordable Care Act (ACA) to choose an Essential Health Benefits (EHB) benchmark plan to serve as a model for all other individual and small business health plans. Beginning in 2022, the Michigan Department of Insurance and Financial Services (DIFS) has approved the Priority Health HMO plan as the state’s Essential Health Benefits (EHB) benchmark plan.
- Designations: The EHB plan is designed to mirror the variety of services provided by a “typical employer plan” in the state, as well as the quantitative constraints placed on those services. This is Priority Health’s third time receiving this honor, and the company’s HMO plan is the only one to serve as the state EHB in the first ten years of the Affordable Care Act.
- Changes: Since the state’s market changes took effect in 2014, the Priority Health HMO plan has acted as the benchmark. Priority Health will continue to be the EHB plan until 2027 when the state will be compelled to designate an EHB once more.
- Benchmark plan: “Remaining the designated benchmark plan in the state is a reflection of how we take care of our members,” said Praveen Thadani, Priority Health President. “This year, we are proud to be recognized for combating this State’s opioid crisis, while continuing to offer affordable, high-quality coverage to Michigan residents.”
- Categories: DIFS has established ten categories in which the EHB benchmark plan must deliver benefits. 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, preventative and wellness services, chronic disease management, and pediatric services are among the categories (including oral and vision care).
- Diversity: Priority Health is Michigan’s second-biggest health plan, with over 30 years of experience providing a diverse range of health benefits to employers and individuals, including Medicare and Medicaid programs. Priority Health continues to be recognized as a leader in quality, customer service, transparency, and product innovation, serving over a million members each year and providing a comprehensive network of primary care physicians in Michigan.
