ACA – Benchmark Health Insurance Plan Selection
The Kansas Insurance Department submitted a Letter of Intent to apply for the State Flexibility to Stabilize the Market Cycle II Grant in December of 2020. The grant application was submitted in February of 2021 and was awarded in September of 2021.
The grant provides a funding source to enhance and support the role of States in implementation and planning for several of the Federal market reforms and consumer protections under Part A of Title XXVII of the Public Health Service Act (PHS Act): Section 2702 Guaranteed Availability of Coverage; Section 2703 Guaranteed Renewability of Coverage; Section 2707 Non-discrimination under Comprehensive Health Insurance Coverage (Essential Health Benefits Package). Kansas sought funding under all three sections with a focus on Section 2707-Nondiscrimination under Comprehensive Health Insurance.
In the time since the grant was awarded the department initiated an RFP and selected Lewis & Ellis Actuaries and Consultants based in Overland Park, Kansas as the contractor. Lewis & Ellis staff began an assessment of the Kansas EHB-Benchmark Plan which included comparing the Kansas EHB-Benchmark Plan to the same plan in other states, reviewing consumer complaints and sending data calls to the Kansas carriers writing major medical coverage in the individual and small group markets in Kansas.
Lewis & Ellis has made a recommendation to the Kansas Insurance Department which includes adding the following benefits as Essential Health Benefits in the State of Kansas beginning for Plan Year 2025. The recommendations include: Hearing aids by prescription for insureds with severe or profound hearing loss, and over the counter (OTC) hearing aids for insureds with mild or moderate hearing loss; and Medically necessary bariatric surgery for insureds with a body mass index (BMI) of 35 or higher and an obesity-related comorbidity; and Medically necessary applied behavioral analysis (ABA) for insureds with autism spectrum disorder (ASD).
We will convene the first meeting of interested stakeholders on Friday, March 3, 2023 at the Kansas Insurance Department at 8:30 AM. The department’s address is 1300 SW Arrowhead Road, Topeka, Kansas 66604. There is visitor parking on the west side of the building with overflow parking available directly across Arrowhead Road at the south end of the lot.
Please RSVP to Julie Holmes at Julie.Holmes@ks.gov .
Kansas will accept public comment on the State’s selection of an EHB-benchmark plan. Please submit comments to firstname.lastname@example.org . Please include “EHB-Benchmark Plan Selection” in the subject line or title of your document. The deadline to submit comments is April 11, 2023.
Lewis and Ellis Recommendation
EHB Benchmark Presentation Slides
Council of Autism Service Providers