SCC Bureau of Insurance Seeks Public Comments Regarding Essential Health Benefits Benchmark Plan

The State Corporation Commission's Bureau of Insurance is seeking public comment on proposed updates to the state's Essential Health Benefits (EHB) benchmark plan.

Comments may be sent to [email protected] through May 5, 2026. All comments will be posted publicly.

The EHB benchmark plan sets the required benefits that must be included in comprehensive fully insured individual and small-group health insurance coverage issued in Virginia. The updated plan would take effect in 2028, pending federal approval.

Virginians have an opportunity to review the proposal and submit comments on the draft application to be sent to the federal Centers for Medicare and Medicaid Services, or CMS. CMS must approve the final plan before it can take effect.

To help shape the proposal, the bureau met with a range of stakeholders in 2024 - including insurers, consumer groups and medical experts - to evaluate which benefits should be added. The Health Insurance Reform Commission then held two public hearings. The reform commission recommended the inclusion of the following new benefits to the Commonwealth's benchmark plan:

• Doula care
• Infertility diagnosis and treatment (including iatrogenic infertility and standard fertility preservation procedures)
• Hearing aids
• Pasteurized donor human breast milk
• Care for PANDAS/PANS (pediatric autoimmune neuropsychiatric disorders)
• Treatment for polycystic ovary syndrome (PCOS)

These benefits are included in the proposed benchmark plan as directed by the 2026 session's House Bill 328. While the governor has suggested changes to the law's effective date, the list of required benefits to add to the benchmark plan remains unchanged.

 Virginians can view the proposed plan and learn more.

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Contact: Katha Treanor, 804-371-9141

https://www.scc.virginia.gov/consumers/insurance/health-insurance-consumer/about-the-affordable-care-act/essential-health-benefits-benchmark-plan/