What is Covered in Essential Health Benefits?

Comprehensive health insurance offers some coverage for every aspect of health care, including doctor visits, prescription drugs, hospital stays, and surgery. The Affordable Care Act requires major medical plans to offer these 10 categories of services at a minimum as part of the essential health benefits:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • 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)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including pediatric dental and vision

Be sure you are aware of these, and any other benefits available to you, so you ensure you are maximizing your insurance coverage.

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