DIFS recommends Priority Health HMO plan continue as Michigan’s EHB benchmark health insurance plan for 2022

(Grand Rapids, Mich. – September 21, 2021) The Affordable Care Act (ACA) requires each state to select an Essential Health Benefits (EHB) benchmark plan to serve as a reference for all other individual and small business health plans to follow. The Michigan Department of Insurance and Financial Services (DIFS) has once again recommended the Priority Health HMO plan to serve as the Essential Health Benefits (EHB) benchmark plan for the state starting in 2022. 

The EHB plan is intended to reflect both the scope of services and quantitative limits on those services by a “typical employer plan” in the State. This is the third time Priority Health has earned this designation, and the company’s HMO plan remains the only plan to serve as the state EHB in the first 10 years of the ACA. The Priority Health HMO plan has served as the benchmark for the state since 2014, when the market reforms went into effect. The Priority Health plan will remain the EHB plan through 2027, when the state will once again be required to designate an EHB. 

“Remaining the designated benchmark plan in the state is a reflection of how we take care of our members,” said Praveen Thadani, Priority Health President. “This year, we are proud to be recognized for combatting this State’s opioid crisis, while continuing to offer affordable, high quality coverage to Michigan residents.”

In selecting the new benchmark plan for 2022, the Centers for Medicare & Medicaid Services (CMS) encouraged states to consider the potential impact on vulnerable populations, specifically how it would help address the opioid crisis in their respective states. DIFS added the following two new benefits in Michigan’s benchmark plan for year 2022:

  • 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.

The selected EHB benchmark plan must 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, preventative and wellness services and chronic disease management, and pediatric services (including oral and vision care). Small business and individual market plans – offered both on and off HealthCare.gov – must meet the benefit standard set by the EHB benchmark plan.

Additional information regarding Michigan’s current EHB benchmark plan and the updates for the 2022 plan year are available online at the DIFS EHB Information webpage.

About Priority Health:

With over 30 years in business, Priority Health is the second largest health plan in Michigan, offering a broad portfolio of health benefits options for employer groups and individuals, including Medicare and Medicaid plans. Serving more than a million members each year and offering a broad network of primary care physicians in Michigan, Priority Health continues to be recognized as a leader for quality, customer service, transparency and product innovation. Learn more about affordable, quality health coverage options from Priority Health.