DIFS recommends Priority Health HMO plan as Michigan's benchmark health insurance plan for 2017

(Grand Rapids, Mich. - July 21, 2015)
In an executive report published this month, the Michigan Department of Insurance and Financial Services (DIFS) recommended the Priority Health HMO plan continue to serve as the Essential Health Benefits benchmark for the state starting in 2017.

The report states: "As in the EHB [Essential Health Benefits] benchmark selection in 2012, DIFS' benchmark plan recommendation for 2017 reflects the need to provide Michigan consumers with a benchmark plan that offers comprehensive coverage and affordable rates."

As a requirement of the Affordable Care Act, each state is required to select an Essential Health Benefits "benchmark plan": A plan that will serve as a reference plan for all other health plans to follow for individual and small business health plans, reflecting both the scope of services and quantitative limits on those services by a "typical employer plan" in the State.

"DIFS believes that the selection of the Priority Health HMO plan achieves the best balance between comprehensiveness and cost-effectiveness for Michigan consumers," the report goes on to say. "The Priority Health HMO plan offers a wide range of benefits and will provide an excellent framework for all individual and small group plans offered in Michigan for plan year 2017."

An EHB benchmark health insurance plan is chosen by each state every five years. Priority Health was also selected as the state's benchmark plan in 2012 and is the only health plan in Michigan to have earned this designation.

"We strive to provide the best quality health plans to all Michigan residents," said Michael P. Freed, president and CEO for Priority Health. "Being designated the benchmark plan for the second time reflects what our customers already know, that we offer the highest quality, and best value and choices in the state."

Categories of essential health benefits

The selected Essential Health Benefits benchmark plan must be offered both on and off the Health Care Exchange and provide benefits in 10 categories defined by DIFS. The categories are:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services (including behavioral health treatment)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management pediatric services (including oral and vision care)

DIFS presented this recommendation to the U.S. Department of Health & Human Services. A final decision is expected later this month.

About Priority Health:

Priority Health is an award-winning, Michigan-based non-profit health plan nationally recognized for improving the health and lives of the people it serves. It continues to lead the industry in engaging members in their health, delivering effective health and disease management programs and working with physicians to improve health care outcomes and performance. Priority Health is one of only 20 health plans nationwide offering wellness programs accredited by the National Committee for Quality Assurance, an organization which also rated it among the best health plans in the nation. The State of Michigan named the Priority Health HMO the benchmark plan for all individual and group HMO plans to model.

Priority Health offers a broad portfolio of health benefit options for employer groups and individuals, including Medicare and Medicaid plans. Its network of health care providers features 95 percent of practicing physicians available in Michigan and more than 900,000 health care providers nationwide.