Essential Health Benefits

All health insurance plans now share some common characteristics. The Affordable Care Act requires that all health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits.

These benefits fit into the following 10 categories:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs. For more information about prescription drug benefits, visit the page Prescription Drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management. For more information about preventive services with no cost sharing, click here.
  • Pediatric services, including dental and vision care. Dental insurance for children is included in the price of all health plans purchased in the exchange.

The requirement for insurance plans to offer essential health benefits is just one of many changes in health coverage that began in 2014.

Read more about coverage basics: