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Healthcare Frequently Asked Question

What are Essential Health Benefits?...
February 27, 2013

What are Essential Health Benefits?


Answer:
The Affordable Care Act (ACA) requires each individual and small group plan to offer a series of basic coverages called Essential Health Benefits (EHBs). Each plan must include coverage for the following ten categories:

  • 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

Each state is required to establish an EHB benchmark plan from the above list to serve as the benefit standard for the state. If a state doesn’t submit a benchmark plan, then the Federal Government will do so for the state. If a benchmark plan doesn’t include all the coverage categories, as listed above, then the state will be required to supplement the benefits.

To view more healthcare FAQs, visit: http://www.pianet.com/faq/health-care-reform-faq.

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