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. 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
• 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

According to the Affordable Care Act, plans that cover benefits designated as Essential Health Benefits must cover these benefits with no annual limits or lifetime maximums.

This is a brief overview of Essential Health Benefits required by the Affordable Care Act. You should thoroughly understand the benefits offered before purchasing any insurance policy.