What Are Essential Health Benefits?

Posted on May 13, 2013

Essential Health Benefits are basically what the Affordable Care Act says must be covered with no lifetime maximums, on every fully insured small group and individual health insurance policy starting January 1st, 2014 (or on the first day of the plan year following January 1st, 2014):

• Ambulatory patient services
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health services
• Pediatric services, including oral and vision care
• Prescription drugs
• Preventive and wellness services and chronic disease management
• Rehabilitative and habilitative services and devices

However, lifetime and annual limits can be placed on “Non-Essential Health Benefits” such as:

• Acupuncture
• Dental services (accidental)
• Food / nutritional supplements
• Hearing aids
• Hospice
• Infertility (including Rx)
• Obesity surgery
• Orthotic braces
• Ostomy supplies
• TMJ
• Vision exams
• Wigs

Health plans in or out of the Colorado Health Insurance Exchange must cover Essential Health Benefits. At Sage Benefit Advisors, we are closely following all the coming changes and regulations so we’ll be able to help you through the process of selecting the most appropriate plan for your situation. Give us a call! 970.484.1250

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