Essential Health Benefits

Under the Affordable Care Act (ACA), health plans offered in the individual and small group markets are required to offer comprehensive coverage, known as essential health benefits (EHB).

The ACA requires EHBs to include items and services in at least the following 10 categories:

Ambulatory patient services

Emergency Services

Maternity and newborn care

Mental health and substance use disorder services, including behavior health treatment

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventative and wellness services and chronic disease management

Pediatric services, including oral and vision care (See 42 USC §18022)

Hospitalization

The US Department of Health and Human Services (HHS) allows states the flexibility to provide a recommendation for EHBs from 10 benchmark plans which HHS has identified as reflecting the services of a typical employer plan. HHS has issued some additional guidance to states but ultimately this approach will allow for greater flexibility in the plan selection and meet the specific needs of Kentuckians.

Kentucky Department of Insurance

Essential Health Benefits

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