Your Source for Health Reform

Topic: Benchmark Plan



To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as essential health benefits. In implementing this requirement, states were asked to select a “benchmark plan” to serve as a reference point for designing health plans that meet ACA rules.


Essential Health Benefits Benchmark Plan

Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur has been selected as the benchmark essential health benefits plan for the state of Illinois. This spreadsheet provides a detailed summary of conditions for coverage or limitations for subcategories and services under each of the 10 essential health benefits.

Essential Health Benefits Benchmark for Illinois

After several meetings, the Essential Health Benefits Workgroup convened by the Governor’s office presented their final recommendation in September 2012 for Illinois’ Essential Health Benefits benchmark plan. This plan will be the reference point for all non-grandfathered individual and small group health plans sold inside and outside of the Illinois Health Insurance Exchange beginning in 2014.

Essential Health Benefits: Building a Better Benchmark

Slides from the Center on Budget and Policy Priorities’ webinar on the Essential Health Benefits benchmark plan and how each state is to create that benchmark plan.

State of Illinois Comparison of Benchmark Options

These are the plans that the state is using to choose as its benchmark small group plan. They are grouped into the 10 categories of Essential Health Benefits required by the ACA.

Illinois Essential Health Benefits FAQ

This FAQ from the Illinois Health Care Reform Implementation Council provides the Basic Facts and State Options for deciding the state’s Essential Health Benefits package. A decision needs to be made by September 30, 2012.

Letter to DOI: Essential Health Benefits

A letter by several groups involved with chronic conditions sent in May 2012 to the director of the Illinois Department of Insurance, asking that the department to make information available regarding to potential benchmark plans for Illinois’ Essential Health Benefits plan. The letter lists 31 health plan benefits that are important in treating heart disease, diabetes, cancer, multiple sclerosis, and stroke.

Essential Health Benefits Benchmark Options Evaluative Tool for Chronic Disease Patients

A tool designed by a group of Illinois Health Advocacy organizations (American Cancer Society, American Diabetes Association, American Heart Association, American Stroke Association, National Multiple Sclerosis Society).

5 Key ACA Standards that Will Impact Family Planning

This May 2011 document from the National Health Law Program, or NHeLP, explains these Affordable Care Act terms – Qualified Health Plans, Essential Health Benefits, Benchmark Plans, Preventive Care, and Essential Community Providers. A grasp of the complex ways these new standards interact with each other is key to understanding how access to family planning services will be impacted in Medicaid and the insurance exchanges.