Essential Health Benefits

The benefits covered in today’s health insurance can vary widely from plan to plan, carrier to carrier and state to state.  The ACA will create a more uniform standard of benefits.  The ACA requires that all individual and small group coverage includes certain procedures and treatments deemed “essential health benefits”.

The following ten categories were determined to be essential health benefits:

• 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 and chronic disease management; and
• Pediatric services, including oral and vision care

Essential health benefits must be included in all four levels of coverage that carriers can offer.  The coverage levels are often referred to as “Metal Plans” and are categorized as bronze, silver, gold and platinum.  As you can imagine each level offers different coverage levels (actuarial values) with bronze being the lowest and platinum being the highest.  Nonetheless all will offer the same level of EHB’s.  To learn more about Metal Plans click here.