Washington Proposed EHB Benchmark Plan Approved by CMS

December 10, 2024

EGWP marketplace medicaid Medicare

Washington’s Office of the Insurance Commissioner (OIC) recently received approval from CMS to add three new benefits to their Essential Health Benefits (EHB) benchmark plan beginning in the 2026 plan year.

The benchmark plan will include an artificial insemination benefit, excluding donor semen or eggs, or services related to procuring or storing materials; coverage for human donor milk in an inpatient setting for an infant who is medically or physically unable to receive maternal human milk; and a hearing aid benefit.

An actuarial analysis performed by Wakely Consulting stated there is a projected total cost increase of 0.09% as a percent of total allowed claims relative to the current benchmark. In addition, the state legislature will consider in 2025 adding in vitro fertilization as a mandated benefit for all fully insured plans.

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