Government and Health Care

Health plan earns designation as Michigan benchmark

July 22, 2015
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Health plan opens 'insurance shops'
Grand Rapids-based Priority Health operates retail information centers, or insurance shops, in Michigan. Courtesy Priority Health

A local health plan by a local provider is being recommended to serve as Michigan’s benchmark plan.

The Michigan Department of Insurance and Financial Services, or DIFS, released this month its executive report on Michigan’s 2017 Essential Health Benefits Benchmark Plan, which recommends continuing the use of the Priority Health HMO plan as the benchmark for the state.

Benchmark process

DIFS made its recommendation to the U.S. Department of Health & Human Services based on Priority Health's coverage and affordable rates, according to the report.

The HMO plan was chosen from among 10 potential candidates, including plans from Blue Cross Blue Shield of Michigan, Federal Employee Health Benefit BCBS and Physicians Health Plan.

Each state is required to select a base benchmark plan every five years, and Priority Health HMO was also selected in 2012 for recommendation.

Since the plan for 2017 is also substantially similar to the plan selected in 2012, it will promote continuity in small group and individual markets.

“Being designated the benchmark plan for the second time reflects what our customers already know — that we offer the highest quality and best value and choices in the state,” said Michael Freed, president and CEO, Priority Health in Grand Rapids.

Balanced plan

DIFS indicates in that executive report that it “believes the selection of the Priority Health HMO plan achieves the best balance between comprehensiveness and cost-effectiveness for Michigan consumers.”

The Affordable Care Act requires that all non-grandfathered health insurance plans offered in the small group and individual markets meet a number of essential health benefit categories: ambulatory patient services; hospitalization; maternity and newborn care; prescription drugs; rehabilitative services; preventive and wellness services; and pediatric services.

Supplemental recommendations

DIFS also selected the Federal Employee Dental and Vision Insurance Program pediatric vision plan and the MIChild dental plan as supplemental plans.

A supplemental benefit plan complements the base plan in areas where it doesn’t provide all the required services, such as in pediatric preventive services or pediatric oral and vision services.

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