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Benchmark Plan

Updated 03/12/2020

Frequently Asked Questions

  • The current benchmark plan can be found here: DIFS - EHB Information

  • 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.

  • 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.

  • 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.

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