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DIFS Seeks Public Comment on Michigan Essential Health Benefits Benchmark Plan Update to Enhance Benefits for Opioid Addiction Prevention and Treatment

State is updating the EHB-benchmark plan for plan year 2022 to include certain additional benefits addressing opioid addiction and overdose

Media Contact:  Andrea Miller
Media: 517-284-8668
Consumer Hotline: 877-999-6442
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(LANSING, Mich.) The Michigan Department of Insurance and Financial Services (DIFS) is seeking public comment on proposed updates to Michigan’s Essential Health Benefits (EHB) benchmark plan for the 2022 plan year.  Pursuant to greater flexibility offered to states by the Centers for Medicare and Medicaid Services (CMS), DIFS has elected to modify the EHB-benchmark plan for the 2022 plan year to add two new benefits to assist in reducing opioid addiction and overdose.

The Patient Protection and Affordable Care Act requires non-grandfathered plans in the individual and small group markets, both on and off the Exchange, to cover EHBs in ten categories based on the state’s EHB-benchmark plan.  DIFS first selected a benchmark plan in 2012 for use in the 2014 to 2016 plan years and re-assessed its selection for plan year 2017, opting to retain a substantially similar benchmark plan to promote continuity in the individual and small group markets. 

For plan year 2020 and after, CMS provides states three new options for modifying their EHB-benchmark plan:

  • Selecting another state’s 2017 EHB-benchmark plan;
  • Replacing one or more categories of EHBs in the state’s EHB-benchmark plan used for plan year 2017 with the same category or categories of EHB from another state's EHB Benchmark Plan used for plan year 2017; or
  • Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.

For plan year 2022, DIFS proposes utilizing option three by adding the following benefits to Michigan’s current EHB-benchmark plan:

  • Coverage of at least one intranasal spray opioid reversal agent when prescriptions of opioids are dosages of 50MME or higher.
  • Removal of barriers to prescribing Buprenorphine or generic equivalent products for medication-assisted treatment of opioid use disorder.

Additional information regarding the proposed updates to Michigan’s EHB-benchmark plan for the 2022 plan year are available online at the DIFS EHB Information webpage

This information includes materials regarding Michigan’s current EHB-benchmark plan, an Actuarial Report and Certification affirming that Michigan’s EHB-benchmark plan proposed for plan year 2022 meets certain federal requirements, Michigan’s EHB-benchmark Plan’s Benefits and Limitations Summary, Formulary Drug List containing applicable RxNorm Concept Unique Identifiers, and State Confirmations that the proposed EHB-benchmark plan for the 2022 plan year satisfies applicable federal regulations. 

Public comments will be accepted until 5:00 p.m. on April 24, 2020, and should be sent electronically to