Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Friday, January 25, 2013

Illinois Essential Health Benefits Benchmark Plan

The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan.

This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits" by the Affordable Care Act), and all non-grandfathered individual and small group health plans sold in Illinois must measure up to this plan in "actuarial value." Actuarial value is an estimate of the overall financial protection provided by a health plan. (For a great explanation of Actuarial Value, check out this recent Consumers' Union report).
 

The Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan is the largest small group plan in Illinois, making it the default plan if Illinois failed to select a plan, as stated in the Affordable Care Act. According to this Illinois Department of Insurance report, the plan was the third leanest plan out of the 10 options considered. It is a PPO and it covers all of the services that Illinois law mandates, such as treatment for autism and infertility. But it doesn't cover extra services such as massage or acupuncture. The plan is supplemented by All Kids for pediatric dental and the Federal Vision Insurance Plan for children’s vision.
 

We have been following the establishment of an EHB benchmark in the state closely; you can read up on the EHB selection process in Illinois here and here.

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