The Affordable Care Act and You: 10 essential health benefits insurers must now offer

The Affordable Care Act is changing how Americans receive health care.  Plans are changing across the board and often the topic of Essential Health Benefits is mentioned as the driving force behind many of the changes.  What are these 10 Essential Health Benefits, or EHBs, that everyone is referring to?

  1.  Ambulatory Patient Services – This is outpatient care and the most common form of health care.
  2. Prescription Drugs – All plans will cover at least one drug in every category and class in the US Pharmacopeia, the official publication of approved medications in the US.
  3. Emergency Care – Visits do not require pre-authorization.
  4. Mental Health Services – This benefit could be new to your plan, as many current plans do not carry this coverage.
  5. Hospitalization – Your insurer must cover your hospitalization, but with co-pays and deductibles.
  6. Rehabilitative and Habilitative Services – Existing coverage will expand under most plans.
  7. Preventive and Wellness Services – Insurers are now required to provide 50 preventative services at no extra cost.
  8. Laboratory Services – Preventive screening tests are covered, while “diagnostic” tests may not be.
  9. Pediatric Care – This is directed at Dental and Vision care.  Children under the age of 19 now will be covered for cleanings, x-rays, fillings and medically necessary orthodontia.  Eye exams and one pair of glasses or contacts included as well.
  10. Maternity and Newborn Care – This change now classifies prenatal care as a preventative service that must be provided at no extra cost.

The new law mandates that every carrier participating in the exchanges offer the 10 Essential Health Benefits and set certain standards that all insurers must meet, whether they are providing health insurance through an employer or directly to individuals and small groups.

Prior to the law only 2 percent of existing individual health plans provide all 10 essential benefits.  On average, today’s plans offer 76 percent of these benefits.

Health plans and options are changing,  so be sure to consult with BCN Services if you have questions or concerns about how your health benefits will be affected by these Essential Health Benefits.  Read more here. Contact us at 1-800-891-9911 or email us at hr@www.bcnservices.com.

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