The Patient Protection and Affordable Care Act (ACA) requires benefit plans offer a minimum set of essential health benefits. Those include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation and habilitative services and devices, and laboratory services.

The Virginia Department of Medical Assistance Services retained PricewaterhouseCoopers LLP (PwC) to analyze potential benchmark health benefit plans to determine the extent of essential health benefits coverage and Virginia mandated benefits coverage. In their report, Preliminary Analysis of Essential Health Benefits, Benefit Mandates, and Benchmark Plans, PwC details the results of their analysis.

The study found nominal differences in the range of covered benefits across benchmark plan options, with the exception of maternity services. Assuming a one to four percent cost increase, they saw a need to minimally augment Individual and Small Group premiums to account for essential maternity and newborn care coverage.

The report also found that an evaluation of benchmark plan options should also take into consideration optional coverage, such as Virginia’s mandatory benefit offers and non-formulary drugs, along with the relative importance of certain benefits and appropriate benefit limits for items like chiropractic care, hearing aids, and telemedicine. The report offers a preliminary estimated average premium increase of two to four percent to collectively account for these other services. Additional analysis would be necessary to establish Virginia’s final benchmark plan.

To read or download the full report, click here (PDF).