Essential Health Benefit Issues

Patients need to be assured that their health coverage will cover most of their health needs.

The Affordable Care Act mandated that health insurance plans sold on the individual and small group markets must cover 10 essential health benefits:

  1. Ambulatory patient services (outpatient care)
  2. Emergency services.
  3. Hospitalization (inpatient care)
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment.
  6. Prescription drugs.
  7. Rehabilitative and habilitative services and devices.
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management;
  10. Pediatric services, including oral and vision care.

These requirements help ensure that coverage sold on these markets is robust enough to cover most consumers' needs.

The AHA opposes attempts to erode these consumer protections. All individuals should be assured that their coverage is comprehensive and will meet their needs.

Related Resources

Letter
Public
AHA comments to CMS on the proposed rule amending the definition of short-term, limited-duration health insurance.
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On April 9, CMS issued a final rule and related guidance that will implement the standards governing health insurance issuers and the Health Insurance…
Letter
Public
Letter
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Letter
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Special Bulletin
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Rep.