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 Texas

Plans sold on the Texas 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

Texas selected Blue Choice PPO RSH3, a Small Group Market product from Blue Cross Blue Shield of Texas, as its benchmark for plan years 2025 through 2027.

Texas's Essential Health Benefits benchmark plan is the reference standard that individual and small-group health plans sold in the state are measured against. It is not any one reader's policy: an issuer may substitute benefits, and a 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.

TEXAS 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 Blue Cross Blue Shield of Texas Product Name Blue Choice PPO Plan Name Blue Choice PPO RSH3

Page 1 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. The summary block in document order, from the Plan Type line to the line before Supplemented Categories.

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.

Texas 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 it prints no anti-obesity 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 one plan lives in that plan's own formulary.Texas's EHB benchmark summary lists no anti-obesity drug 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.	TEXAS 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 Alcohol Deterrents/Anti-craving 2 Page 5 of the summary chart PDF. 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 a class the table never lists is a class the document does not address, rather than a class the benchmark carries none of. Runs of spaces collapsed to one.
bariatric surgery	Not coveredThe benchmark chart marks bariatric surgery not covered. That is a statement about this benchmark row. A plan sold in the state may still cover the service under a different benefit, and the plan's own documents decide. This is not an essential health benefit in the Texas benchmark.	TEXAS 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 No Not Covered No Page 2 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one.
weight-loss programs	Not coveredThe benchmark chart marks weight loss programs not covered. That is a statement about this benchmark row. A plan sold in the state may still cover the service under a different benefit, and the plan's own documents decide. This is not an essential health benefit in the Texas benchmark. Certain weight loss services such as nutritional and diet counseling are available through a diabetes management plan, autism benefits, and for adults at higher risk of chronic disease.	TEXAS 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 No Not Covered No Certain weight loss services such as nutritional and diet Page 3 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one.
nutritional counseling	Not coveredThe benchmark chart marks nutritional counseling not covered. That is a statement about this benchmark row. A plan sold in the state may still cover the service under a different benefit, and the plan's own documents decide. This is not an essential health benefit in the Texas benchmark. Certain weight loss services such as nutritional and diet counseling are available through a diabetes management plan, autism benefits, and for adults at higher risk of chronic disease.	TEXAS 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 Certain weight loss services such as nutritional and diet Page 4 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces 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

TEXAS 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 Blue Cross Blue Shield of Texas Product Name Blue Choice PPO Plan Name Blue Choice PPO RSH3
Page 1 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one. The summary block in document order, from the Plan Type line to the line before Supplemented Categories.
TEXAS 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 No Not Covered No
Page 2 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one.
TEXAS 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 No Not Covered No Certain weight loss services such as nutritional and diet
Page 3 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one.
TEXAS 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 Certain weight loss services such as nutritional and diet
Page 4 of the summary chart PDF inside the ZIP, read from the PDF text layer with runs of spaces collapsed to one.
TEXAS 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 Alcohol Deterrents/Anti-craving 2
Page 5 of the summary chart PDF. 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 a class the table never lists is a class the document does not address, rather than a class the benchmark carries none of. Runs of spaces collapsed to one.