If you’ve been following the discussion surrounding the ACA, you may have heard the term “Essential Benefits” thrown around. This term refers to what plans must cover to comply with the law. These are the minimum requirements of an insurance plan. The benefits include a range of preventative services, preexisting conditions, and other vital healthcare costs that could financially harm a person if he or she had to pay for them all by themselves.
Here are the ten essential benefits that insurance plans must cover:
- Ambulatory Services: This refers to outpatient care you receive without being admitted to the hospital.
- Hospitalization: This requirement includes coverage for overnight stays and surgery.
- Emergency Services: Services that occur in the emergency room and are extremely urgent in nature.
- Pregnancy/Newborn Care: This coverage includes pregnancy, maternity, and newborn care both before and after the birth of the infant.
- Mental Health and Substance Abuse Care: Counseling and therapy are two integral parts of this minimum requirement.
- Rehabilitative Services: these services include those that help people with injuries, disabilities, and/or chronic disorders who require therapy to regain physical and cognitive skills.
- Preventative Services: also known as “wellness” services, these include management of chronic diseases.
- Laboratory Tests: ranging from blood draws, cultures, sputum samples, etc
- Prescription Drugs: medications that were prescribed by your medical provider
- Pediatric Services: while these services include dental and vision coverage for children, dental and vision are not required coverage for adults.
In addition to these vital minimum requirements, there are also additional benefits covered depending on the type of plan in question. Whether these are covered depends on your state’s particular rules; states vary in whether to make these required.