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Shapiro Administration Seeks Public Input on Updating Commonwealth’s Essential Health Benefits Benchmark Plan


Harrisburg, PA – Pennsylvania Insurance Commissioner Michael Humphreys today announced the Pennsylvania Insurance Department (PID) is seeking public input as it considers updating the Commonwealth's essential health benefits (EHB) benchmark plan. An EHB benchmark plan establishes the minimum essential health benefits that individual and small group health insurance plans must offer, pursuant to the Affordable Care Act.

"One of the Shapiro Administration's top priorities is to assist Pennsylvanians in accessing quality comprehensive health insurance plans that help them obtain coverage for necessary healthcare services," said Humphreys. "This public comment period provides an opportunity for Pennsylvanians to tell the Department where their needs are that are not currently being addressed. PID welcomes input, comments, lived experiences and suggestions of benefit types and areas of need."

A notice, scheduled to be published in the July 29 issue of the Pennsylvania Bulletin, announces and outlines the public comment period on what benefits the plan should include, so that Pennsylvanians continue to have access to comprehensive coverage that is consistent with current medical practices.

The Affordable Care Act requires that Pennsylvania's EHB benchmark plan provide coverage for at least the following benefit categories, subject to certain limitations outlined in the notice:

  • 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 and chronic disease management
  • Pediatric services, including oral and vision care

In addition to providing coverage for the above categories, the EHB benchmark plan must be free from discriminatory language and provide benefits for diverse segments of the population, including women, children, persons with disabilities, and other groups. The plan's benefits also must not be unduly weighted toward any of the benefit categories listed above, and must be equal to, or greater than, the scope of benefits provided under a typical employer plan.  Additionally, the financial coverage the plan offers for covered services must be equivalent to the financial coverage offered in certain comparison plans from 2017, including the benchmark plan used in 2017. 

Pennsylvanians deserve access to comprehensive health coverage that covers a wide range of benefits relevant to their health needs. The Shapiro Administration recognizes the necessity of being responsive to these needs, and PID is committed to working with consumers as it considers changes to the benchmark plan. 

Comments from Pennsylvanians may be submitted by email to Comments can also be submitted via mail, Attn: Katie Merritt, Policy Director, 1326 Strawberry Square, Harrisburg, PA 17120.

Comments will be accepted until Friday, September 1, 2023.

For more information, review the Department's Pennsylvania Bulletin notice here

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