ACA – Essential Health Benefits

The Affordable Care Act (ACA) requires that non-grandfathered health plans are required to cover a core package of items and services called “essential health benefits.” This requirements may not apply to self-insured or large group plans.

  1. Ambulatory patient services;
  2. Emergency services;
  3. Hospitalization;
  4. Maternity and newborn care;
  5. Mental health and substance use disorder services, including behavioral health treatment;
  6. Prescription drugs;
  7. Rehabilitative services and devices;
  8. Laboratory services;
  9. Preventive and wellness services and chronic disease management; and
  10. Pediatric services, including oral and vision care.

The essential health benefits must be equal in scope to benefits offered by a “typical employer health plan.” A final rule issued by the U.S. Department of Health and Human Services defines essential health benefits based on state-specific essential health benefits benchmark plans, and provides that all plans subject to the essential health benefits requirements offer benefits substantially equal to the benefits offered by the benchmark plan.

Written by 

Jack is a local California agent that offers plans through traditional health insurance plans. He work with Individuals, Families, Employers and Medicare Beneficiaries. With 15+ years of experience in the health insurance industry, He can help you make the most informed decision for your health coverage.

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