Virginia commission weighs adding coverage items to essential health benefits; $8.08 per-member-per-month limit cited

The Health Insurance Reform Commission on its May meeting reviewed a Bureau of Insurance (BOI) report that outlines options for updating Virginia’s Affordable Care Act essential health benefits (EHB) benchmark plan and estimated the fiscal room available to add benefits.

The commission was presented with a list of candidate benefits — including bariatric surgery, doula care, fertility preservation and infertility treatment, broader hearing-aid coverage, non‑pediatric routine dental, medical nutrition management and weight‑loss drugs — and told the state has about $8.08 per member per month in actuarial value available to add benefits without federal defrayal.

The review matters because the EHB benchmark sets the minimum benefits that individual and small‑group plans must cover in the ACA market. BOI policy advisor Brad Marsh told the commission the federal process requires states to compare their benchmark to a set of federal comparison plans and to ensure any additions stay between the least and…