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.
