Jul 10, 2013
Explaining the Essential Health Benefits provided by the Affordable Care Act
The Affordable Care Act (ACA) mandates that Individual/Family Health Plans and Small Employer Group Health Plans must cover Essential Health Benefits.
The Affordable Care Act requires insurance carriers to provide coverage for a package of Essential Health Benefits (EHB) in 10 benefit categories, effective the first plan year on or after January 1, 2014.
The requirement applies to all fully insured health plans offered in the Small Group and Individual health plans and includes all product types, whether HMO, PPO, POS or high-deductible HRA/HSA. In addition, the requirement affects plans both in and outside the Health Insurance Marketplaces (Exchanges) being established in states for 2014.
The mandate to cover EHB does not apply to fully insured Large Group, self-funded or grandfathered health plans.
The 10 designated benefit categories of essential health benefits are:
Of the designated EHB categories, the only ones that have not been traditionally covered in insured plans are Pediatric Dental and Vision services.