WHAT IS CONSIDERED ESSENTIAL HEALTH BENEFITS?

A set of health care service categories that must be covered by Qualified Health Plans and certain plans.

Essential health benefits must include items and services within at least the following 10 general categories:

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

WHAT IS A “FLEXIBLE BENEFITS PLAN”?
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