Benchmark Plan & Benchmark Plan Design FAQ

  • Updated 03/12/2020

Benchmark Plan
Has Michigan selected its Essential Health Benefits benchmark plan for 2017?

Yes, the following is a link to Michigan’s 2017 EHB Plan Year information: DIFS 2017 EHB Plan Year Information Page

Does the durable medical equipment (DME) list in the benchmark plan become the benchmark for DME supplies?

It is not necessary that carriers duplicate the DME list in the benchmark plan. However, carriers must ensure that the exclusion of any DME does not amount to an exclusion of a required benefit.

Is bariatric surgery an essential health benefit in Michigan?

Yes, Michigan’s benchmark plan includes coverage for bariatric surgery. Accordingly, bariatric surgery is an essential health benefit that must be offered, subject to any medical management techniques carriers may impose.

Are issuers required to offer Autism Spectrum Disorder (ASD) benefits?

Yes, as indicated in Order 13-003-M, ABA treatment for autism is included in Michigan’s EHB “habilitative services” category.  Any QHP offered in Michigan is required to include ABA treatment for ASD.  The Director issued Order 14-017-M to clarify that issuers may not convert annual dollar limits to non-quantitative limits (visit limits, hourly or daily limits) on any statutorily mandated treatment for ASD.  Orders 13-003-M and 14-017-M should be read in conjunction to understand how benefits for ASD must be offered.

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    The answers provided are not meant to be a substitute for legal advice.