Essential Health Benefits (EHBs)

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The ACA requires all (fully insured) non-grandfathered Small Group and IFP policies to include the following 10 categories of care, at standard levels of generosity.

Large Group and self-funded plans are not required to cover any specific EHBs. But if they do, they cannot have lifetime or annual limits imposed on them. Plans that provide Minimum Value (MV) pay these benefits at a minimum 60% or better.

  1. Outpatient care
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, newborn care
  5. Mental health and substance use disorder services; counseling and psychotherapy
  6. Prescription drugs
  7. Rehabilitative and habilitative services
  8. Laboratory services
  9. Preventive care, wellness services, and chronic disease management
  10. Pediatric services, including dental and vision for children