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Code of Federal Regulations Title 45. Public Welfare § 45.156.100 State selection of benchmark plan for plan years beginning prior to January 1, 2020

Current as of January 02, 2025 | Updated by Findlaw Staff

For plan years beginning before January 1, 2020, each State may identify a base-benchmark plan according to the selection criteria described below:

(a) State selection of base-benchmark plan. The options from which a base-benchmark plan may be selected by the State are the following:

(1) Small group market health plan. The largest health plan by enrollment in any of the three largest small group insurance products by enrollment, as defined in § 159.110 of this subpart, in the State's small group market as defined in § 155.20 of this subchapter.

(2) State employee health benefit plan. Any of the largest three employee health benefit plan options by enrollment offered and generally available to State employees in the State involved.

(3) FEHBP plan. Any of the largest three national Federal Employees Health Benefits Program (FEHBP) plan options by aggregate enrollment that is offered to all health-benefits-eligible federal employees under 5 USC 8903.

(4) HMO. The coverage plan with the largest insured commercial non–Medicaid enrollment offered by a health maintenance organization operating in the State.

(b) EHB–benchmark selection standards. In order to become an EHB–benchmark plan as defined in § 156.20 of this subchapter, a state-selected base-benchmark plan must meet the requirements for coverage of benefits and limits described in § 156.110 of this subpart;  and

(c) Default base-benchmark plan. If a State does not make a selection using the process described in this section, the default base-benchmark plan will be the largest plan by enrollment in the largest product by enrollment in the State's small group market.

(d) Applicability date:  For plan years beginning on or after January 1, 2020, § 156.111 applies in place of this section.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 45. Public Welfare § 45.156.100 State selection of benchmark plan for plan years beginning prior to January 1, 2020 - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-45-public-welfare/cfr-sect-45-156-100/

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