Is the benchmark plan my plan?

No. The benchmark is the reference a state selected, and plans sold in the individual and small group markets are measured against it. An issuer can substitute one benefit for another of the same value, and your own plan documents decide what your plan pays for.

Does this page describe my employer plan?

Only if your employer buys insurance from an issuer in this state and the plan is a small group plan. If your employer pays claims out of its own funds, no state benchmark reaches your plan and your plan document sets the rules.

What does a row with no answer mean?

It means the benchmark document does not address that benefit. That is a finding about the document, not a coverage rule, and the row names the office to ask instead. A document that is silent is not a document that says no.

This record was last verified on 2026-08-03 and it describes benchmark plan years 2025 through 2027. Benchmark documents are republished on an annual cycle and the whole corpus is re-read every January and July.

Marketplace plan coverage for weight loss treatment in California

Plans sold on the California marketplace are measured against one benchmark plan the state selected, and that document is public. The table below gives what it says about bariatric surgery, weight loss programs and nutritional counseling, with the line it says it in. Your own plan can still differ.

By the Covered Weight editorial team · Updated Aug 3, 2026. Research and sourcing by Evan Reid.

The document this page reads

California selected Small Group HMO 30, a Small Group Market product from Kaiser Foundation Health Plan Inc., as its benchmark for plan years 2025 through 2027.

California's Essential Health Benefits benchmark plan is the reference standard that individual and small-group health plans sold in California are measured against. It is not any particular reader's policy: an issuer may substitute benefits, and a specific plan's own documents decide what that plan pays for. It does not reach a self-funded employer plan at all, and most people with job-based coverage are in one, so a reader on an employer plan should read their plan document rather than this page.

State rules do not reach a self-funded employer plan. If your employer pays claims out of its own funds and hires an insurer to administer them, your plan document sets the rules and this page does not describe it.

CALIFORNIA EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION

Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026

Read the line this comes from

Plan Type Small Group Market Issuer Name Kaiser Foundation Health Plan Inc. Product Name Small Group HMO Plan Name Small Group HMO 30

Page 1 of the summary chart PDF inside the ZIP. Four label-and-value lines, with runs of spaces from the PDF text layer collapsed to one.

What the benchmark says, benefit by benefit

What each label means

Covered: On the benefit, with no gate in front of it.
Covered with conditions: On the benefit once a requirement is met first.
Depends on your plan: Your own plan document decides. No state rule reaches it.
Not covered: The document says no. Read the note for whether an exception exists.
Not published: We looked and nothing is published. The cell names who to ask.

California benchmark plan treatment of weight loss benefits
Benefit	What the document says	The line it says it in
anti-obesity medication	Not publishedThe benchmark document does not address anti-obesity medication. Its prescription drug table lists every category and class the benchmark carries, including classes with a count of zero, and there is no Anti-Obesity Agents row at all. A class the document never lists is a class the document is silent on, which is not the same as a class the plan covers none of. The answer for a specific plan lives in that plan's own formulary.California's EHB benchmark summary lists no Anti-Obesity Agents class. Which prescription drug class does my plan use for weight-loss medication, and where is that plan's formulary published? Ask Health Insurance Marketplace Call Center, Centers for Medicare & Medicaid Services on 1-800-318-2596.	CALIFORNIA EHB BENCHMARK PLAN (2025-2027), PRESCRIPTION DRUG EHB-BENCHMARK PLAN BENEFITS BY CATEGORY AND CLASS Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes from Anti-Addiction/ Substance Abuse Treatment Agents Smoking Cessation Agents 0 A neighbouring row, quoted because an absence cannot be quoted. The table prints a row for a class even when the submission count is zero, so the fact that no Anti-Obesity Agents row exists anywhere in the table means the document does not address the class, rather than that the benchmark carries none. Runs of spaces from the PDF text layer collapsed to one.
bariatric surgery	CoveredCalifornia's benchmark plan covers bariatric surgery and counts it as an essential health benefit. The chart records no quantitative limit, no exclusion text and no explanation, so the benchmark itself sets no procedure cap. An individual plan may still require prior authorization; that is a plan-level fact this document does not carry. This is essential health benefit in the California benchmark.	CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Bariatric Surgery Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes from Bariatric Surgery Yes Covered No Page 2 of the summary chart PDF. Columns A to D of the row: Benefit, EHB, Is the Benefit Covered?, Quantitative Limit on Service? Columns E to H are empty for this row. Runs of spaces from the PDF text layer collapsed to one.
weight-loss programs	CoveredCalifornia is one of the few states whose benchmark chart marks weight-loss programs covered and counts them as an essential health benefit. Most states mark this row not covered. This is essential health benefit in the California benchmark.	CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Weight Loss Programs Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes from Weight Loss Programs Yes Covered No Page 3 of the summary chart PDF. Columns A to D of the row; columns E to H are empty. Runs of spaces from the PDF text layer collapsed to one.
nutritional counseling	Not coveredThe benchmark chart marks nutritional counseling not covered and not an essential health benefit. That is a statement about this benchmark row only. It says nothing about preventive services a plan covers under a different row, and a reader should check their own plan's preventive services list rather than read this row as the whole answer. This is not an essential health benefit in the California benchmark.	CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Nutritional Counseling Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026 Read the line this comes from Nutritional Counseling No Not Covered No Page 5 of the summary chart PDF. Columns A to D of the row; columns E to H are empty. Runs of spaces from the PDF text layer collapsed to one.

Does this page reach your plan?

Which document decides your case depends on who pays your claims. A state program follows the state's own published rules. A marketplace plan is measured against the state benchmark. An employer plan that pays claims out of the employer's funds follows its own plan document and no state rule reaches it, and most people with job-based coverage are on one of those.

Which document governs your plan?

This tool needs JavaScript, because it runs entirely in your browser and sends nothing to us. With JavaScript off, start with the plan-type guides in the navigation instead. The question below is an example of what it asks, not an answer about your plan.

Question 1 of 333%

Where does your health coverage come from?

Pick the one that pays for your prescriptions and your medical visits.

Open the full version on its own page

What a benchmark plan is

Federal rules require plans in the individual and small group markets to cover ten categories of essential health benefits, and each state picks an existing plan as the reference for what those categories mean in that state. Weight loss treatment is not one of the ten categories, so whether it appears at all depends on the plan the state selected. That is why the answer changes at a state line for a benefit that has no federal floor.

When this page does not describe your plan

A benchmark reaches the individual and small group markets. If your employer pays claims out of its own funds, no state benchmark and no state mandate reaches your plan, and the plan document sets the rules instead. Most people with job-based coverage are in a plan of that kind, which makes it the most common way a reader takes the wrong answer from a page like this one. Weight loss coverage on a self-funded employer plan covers how to tell which kind you are on and what to ask for.

Reading a row that says the document is silent

A benchmark summary chart lists the benefits it addresses. When a benefit is not in the chart, the honest statement is that the document does not address it, and the row says so and names who can answer instead. It is not the same as an exclusion, and treating silence as a no is the mistake that makes most coverage tables in this field unusable.

Documents this page reads

Information on Essential Health Benefits (EHB) Benchmark Plans, State Documentation Requirements
Centers for Medicare & Medicaid Services · Federal agency publication · Read Aug 3, 2026
Read the line this comes from
EHB Summary Chart: Provides a summary of the State's EHB-benchmark Plan
The row of the State Documentation Requirements chart that names the summary document every state marketplace record on this site reads.
Information on Essential Health Benefits (EHB) Benchmark Plans, Essential Health Benefits Benchmark Plans, California
Centers for Medicare & Medicaid Services · Federal agency publication · Read Aug 3, 2026
Read the line this comes from
California State-required benefits 2017-2026 EHB Benchmark Plan Information (ZIP)
The California row of the state list, quoted because its plan-year label reads 2017-2026 while the summary document inside the ZIP is titled 2025-2027. The record resolves that disagreement in the conservative direction; see effective_note in marketplace.json.
Contact us, Individuals & families, including self-employed
Centers for Medicare & Medicaid Services · Federal agency publication · Read Aug 3, 2026
Read the line this comes from
1-800-318-2596 (TTY: 1-855-889-4325) Available 24 hours a day, 7 days a week (except holidays)
The Marketplace Call Center number and hours, under the tab printed as the section heading. Quoted because every resolution_path that sends a reader to the Marketplace has to carry a number somebody actually checked.
CALIFORNIA EHB BENCHMARK PLAN (2025-2027), SUMMARY INFORMATION
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Plan Type Small Group Market Issuer Name Kaiser Foundation Health Plan Inc. Product Name Small Group HMO Plan Name Small Group HMO 30
Page 1 of the summary chart PDF inside the ZIP. Four label-and-value lines, with runs of spaces from the PDF text layer collapsed to one.
CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Bariatric Surgery
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Bariatric Surgery Yes Covered No
Page 2 of the summary chart PDF. Columns A to D of the row: Benefit, EHB, Is the Benefit Covered?, Quantitative Limit on Service? Columns E to H are empty for this row. Runs of spaces from the PDF text layer collapsed to one.
CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Weight Loss Programs
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Weight Loss Programs Yes Covered No
Page 3 of the summary chart PDF. Columns A to D of the row; columns E to H are empty. Runs of spaces from the PDF text layer collapsed to one.
CALIFORNIA EHB BENCHMARK PLAN (2025-2027), BENEFITS AND LIMITS, Nutritional Counseling
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Nutritional Counseling No Not Covered No
Page 5 of the summary chart PDF. Columns A to D of the row; columns E to H are empty. Runs of spaces from the PDF text layer collapsed to one.
CALIFORNIA EHB BENCHMARK PLAN (2025-2027), PRESCRIPTION DRUG EHB-BENCHMARK PLAN BENEFITS BY CATEGORY AND CLASS
Centers for Medicare & Medicaid Services · Benchmark plan document · PY2025-2027 · Read Aug 3, 2026
Read the line this comes from
Anti-Addiction/ Substance Abuse Treatment Agents Smoking Cessation Agents 0
A neighbouring row, quoted because an absence cannot be quoted. The table prints a row for a class even when the submission count is zero, so the fact that no Anti-Obesity Agents row exists anywhere in the table means the document does not address the class, rather than that the benchmark carries none. Runs of spaces from the PDF text layer collapsed to one.