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Posted by on Aug 29, 2013 in Healthcare Reform

What are Essential Health Benefits?

What are Essential Health Benefits?

The ACA requires all health plans offered to individuals and small group employers to include a comprehensive package of benefits and services known as Essential Health Benefits.

The Essential Health Benefits 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 services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care

Plans must cover these benefits in order to be certified and offered in the health insurance marketplace.  All Medicaid / Medi-Cal state plans must also cover these services by 2014.