Frequently Asked QuestionsEssential Health Benefits

1. What are Essential Health Benefits?

2. Does the law affect preventive health services?

1. What are Essential Health Benefits?
As a key part of the Health Care Law, all small group and individual health plans must offer a core set of 10 Esential Health Benefits starting in 2014:

  • Preventive, wellness and disease management services
  • Emergency care
  • Ambulatory services
  • Hospitalization
  • Maternity and newborn services
  • Pediatric services, including dental and vision
  • Prescription drugs
  • Laboratory services
  • Mental health, behavioral health, and substance abuse services
  • Rehabilitation and habilitation services

There are no lifetime limits on the amount your health plan spends on these essential health benefits services for you and your family. In addition, insurers will cover 100 percent of the cost of many preventive services, such as wellness visits, immunizations, and screenings for cancer and other diseases when you use an in-network provider. That means you will not pay any deductible, copayments, or co-insurance for many preventive services that can help you stay healthy.

2. Does the law affect preventive health services?
Insurers will cover 100 percent of the cost of many preventive services, such as wellness visits, immunizations, screenings for cancer, and other services. That means you will not pay any deductible, copayments, or coinsurance for many services that can help you stay healthy.