What Are Essential Health Benefits?

Essential health benefits (EHBs) encompass a set of health services that insurers must provide as a part of their qualified health plans. EHBs are prescribed at the federal level, but their implementation is managed by each individual state. Here is an overview of some of the essential health benefits:

1. Preventive Services:

a. Coverage of routine check-ups, screenings, wellness visits, and counseling

services to encourage preventive health.

b. Immunization for children, adults, and expectant mothers.

2. Emergency Services:

a. Treatment for unforeseen life-threatening conditions in cases of medical

emergencies.

3. Ambulatory Patient Services:

a. Physician services such as primary care, specialist visits, and follow-up care

b. Laboratory and radiology services related to patient care.

4. Hospitalization:

a. Services provided during inpatient stays at the hospital.

b. Maternity care and newborn care related to pregnancy and delivery.

5. Prescription Drugs:

a. Coverage of prescribed drugs, typically through a formulary or tiered list

of covered medications.

6. Pediatric Care:

a. Well-child visits, preventive services, diagnosis, and necessary treatments for children and infants.

7. Mental Health and Substance Use Disorder Treatment:

a. Diagnosis and treatment of mental health conditions, including psychotherapy and

medication management.

b. Treatment of substance use disorders and related behavioral therapies.

8. Rehabilitative and Habilitative Services:

a. Rehabilitative therapies such as physical, occupational, and speech therapy.

b. Devices and services that support and improve health status.

9. Laboratory Services:

a. Tests conducted in laboratories for diagnosis, monitoring, and treatment of health conditions.

10. Emergency Room Visits:

a. Visits to hospital emergency rooms for urgent and emergency medical needs.

It's important to note that while these are essential health benefits, some of the specific details may vary based on the state and the insurance plan you choose. It is always advisable to carefully review the plan documents or contact your insurance provider to understand the specific EHBs covered under your policy.