Essential Health Benefits

Summary

The Act defines certain categories of benefits as "Essential Health Benefits." The categories of essential health benefits are:

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

For More Information

• The Basics of Essential Health Benefits (PDF)
• Essential Health Benefits Overview (PDF)
• Essential Health Benefits FAQ (PDF)
• Frequently Asked Questions on Essential Health Benefits Bulletin from the Department of Health and Human Services (PDF)
• Essential Health Benefits Bulletin from the Department of Health and Human Services, Dec. 16, 2011 (PDF)
• Essential Health Benefits Guide for Fully Insured (PDF)