ANNOUNCEMENT
SELECTION OF BENCHMARK PLAN FOR 2026
April 26, 2024
The DC Health Benefit Exchange Authority (HBX) and Department of Insurance, Securities, and Banking (DISB) announce that we are accepting public input on the selection of the Essential Health Benefits (EHB) benchmark plan for plan year 2026. All small group and individual policies sold in the District must include benefits in the essential health benefits benchmark plan.
DC Council adopted a new law, DC Act 25-123, the Expanding Access to Fertility Treatment Amendment Act of 2023. This law requires health insurers to cover a wide range of infertility services, including the diagnosis and treatment of infertility, including in vitro fertilization and standard fertility preservation services.
As permitted by the final rule, Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025, adopted April 3, 2024, DISB, assisted by the HBX, will file an application to amend the District’s benchmark plan to include all infertility services, as required under DC Act 25-123. The District’s current benchmark plan includes infertility diagnosis, testing and counseling. The only amendment to the benchmark plan being applied for is the addition of other infertility services as required under DC Act 25-123.
HBX and DISB staff are developing the full application materials, mandated by the Center for Consumer Information and Insurance Reform (CCIIO), to propose the amendment to the District’s benchmark plan. These materials will be posted on the DISB and HBX websites upon submission.
Interested stakeholders may submit comments electronically to [email protected] or [email protected]. Comments are due by May 31, 2024.
