The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following 10 benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

For plan year 2020, and after, the Final 2019 HHS Notice of Benefits and Payment Parameters provides states with greater flexibility by establishing standards for states to update their EHB benchmark plans, if they so choose.

In the 2020 Final Letter to Issuers Participating on Maryland Health Connection, MHBE was tasked to create a work group to help determine whether the current benchmark plan meets the needs of the individual market. The work group provided recommendations to the MHBE Board of Trustees on whether to leverage new state flexibility to modify the State Benchmark Plan.