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Friday, 20 Oct 2017

Essential Health Benefits

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Essential Health Benefits

The Affordable Care Act has identified a broad set of health care service categories which are required to be covered by most insurance plans beginning in 2014. Essential Health Benefits must be covered by all non-grandfathered health plans in the individual and small group market, Medicaid benchmark and benchmark equivalent plans, and Basic Health Plans.


Required categories include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care


Please click here to see more information on essential health benefits.


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