Essential Health Benefits Benchmark Plans (CMS-10448)

OMB 0938-1174

The Affordable Care Act requires that all qualified health plans (QHPs) offered in the Exchanges provide the essential health benefits (EHB) and be accredited by an accrediting entity that is recognized by the Secretary of Health and Human Services. In order to establish EHB benchmark plans in each State, CMS will collect data from potential default benchmark plan issuers in each State and from States that select their own benchmark. CMS also intends to ask all States for a voluntary submission of their State mandated benefits. This data collection will include: administrative data necessary to identify the plan, all health benefits offered by the plans and associated limits, drug coverage, network type, and plan level enrollment. Finally, we plan to collect submissions from dental plan issuers on whether they intend to apply for certification to participate in the Exchanges as stand-alone plans.

The latest form for Essential Health Benefits Benchmark Plans (CMS-10448) expires 2021-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10448 EHB Benchmark Plan Formulary Drug Form and Instruction
Form CMS-10448 State's EHB-benchmark Plan's Benefits and Limits Form and Instruction
Form CMS-10488 EHB Reporting - EHB Actuarial Certificate Template Form and Instruction
Form CMS-10448 Confirmations on the State EHB-benchmark Plan Form and Instruction
CMS-10448 EHB Substantive Supporting Statement.docx Supporting Statement A
EHB Benchmark Plan Formulary Drug Form and Instruction
State's EHB-benchmark Plan's Benefits and Limits Form and Instruction
EHB Reporting - EHB Actuarial Certificate Template Form and Instruction
Confirmations on the State EHB-benchmark Plan Form and Instruction

All Historical Document Collections

202408-0938-009	Reinstatement with change of a previously approved collection	2024-08-09
202311-0938-014 Comment filed on proposed rule and continue	Revision of a currently approved collection	2024-02-13
202006-0938-008	Revision of a currently approved collection	2020-06-11
202003-0938-018 Comment filed on proposed rule and continue	Revision of a currently approved collection	2020-04-09
201804-0938-010 Approved without change	Revision of a currently approved collection	2018-04-18
201710-0938-009 Comment filed on proposed rule and continue	Revision of a currently approved collection	2017-11-15
201508-0938-010 Approved with change	Revision of a currently approved collection	2015-08-31
201505-0938-012 Withdrawn and continue	Extension without change of a currently approved collection	2015-05-29
201502-0938-010 Comment filed on proposed rule and continue	Revision of a currently approved collection	2015-03-03
201303-0938-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-03-07
201208-0938-009 Approved without change	New collection (Request for a new OMB Control Number)	2012-08-16

OMB Details

Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10488

Data Collection Instructions

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.