Insights

March 22, 2016


Effective Jan. 1, 2017, Vermont will have a new benchmark plan. As a reminder, benchmark plans are important when determining what services and items are required to be provided as essential health benefits (EHB). Non-grandfathered fully insured small group plans must match the state identified benchmark plan’s EHB.

Self-insured and large group insured plans are not required to provide EHB, but when determining which benefits cannot have annual or lifetime dollar limits applied, it is important for the plans to identify EHB. Thus, for administration purposes, many self-insured and large group plans will identify a state benchmark plan to match its EHB.

The new benchmark plan name will be Silver CDHP Plan and it will replace BlueCare, which is also from The Vermont Health Plan. Some of the changes include:

  • The $2,000 annual limit for private duty nursing has been removed as well as the requirement for prior approval for such services.
  • The $10,000 lifetime limit for bariatric surgery has been removed.
  • The 12 visit annual limit for chiropractic care has been removed as well as the requirement for prior approval after 12 visits.
  • Rehabilitative speech therapy, rehabilitative occupational and rehabilitative physical therapy were previously not identified as EHB. They are now covered EHB with a 30 visit per plan year limit for each.
  • Dialysis, allergy testing, diabetes education, infusion therapy and temporomandibular joint disorder are all newly added EHB and thus, covered services.
  • The $35,000 per transplant limit has been removed.

2017 Benchmark Plan »