What are Essential Health Benefits?

December 21, 2013

All new individual and family plans issued January 1, 2014 or after must include coverage for Essential Health Benefits. No insurance company can put a yearly or lifetime maximum on Essential Health Benefits so you'll never run out of insurance for core care.


The essential health benefits include at least the following items and services:


  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)​

  2. Emergency services

  3. Hospitalization (such as surgery)

  4. Maternity and newborn care (care before and after your baby is born)

  5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

  6. Prescription drugs

  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

  8. Laboratory services

  9. Preventive and wellness services and chronic disease management

  10. Pediatric services


Essential Health Benefits are minimum requirements for all new individual and family plans. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side on the AHIPE private exchange.

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