Essential Health Benefits
Essential Health Benefits
Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB).
Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories. These essential health benefits include at least the following items and services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services including oral and vision care
According to the Affordable Care Act, plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.
The opinions expressed in this material are for general informational purposes and should not be considered a solicitation for the purchase or sale of any products. The information contained in this article was developed from sources believed to be accurate. This material is not intended as tax or legal advice. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal and/or tax professionals for specific information regarding your individual situation. For more complete information please access the government website www.healthcare.gov. AGE-6766686.1 (7/24)(Exp. 7/26)