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Essential Health Benefits

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The Affordable Care Act (ACA) includes a number of consumer protections designed to help more Americans gain access to health insurance.

Starting in January 1, 2014, all non-grandfathered individual and small group health insurance plans – including those sold in Your Health Idaho – must cover certain essential health benefits (EHBs). These EHBs include at least the following items and services:

  • Ambulatory patient services – outpatient care you get without being admitted to a hospital
  • Emergency services
  • Hospitalization
  • Maternity and newborn care – care before and after your baby is born
  • Mental health and substance use disorder services, including behavioral health treatment – this includes counseling and psychotherapy
  • Prescription drugs
  • Rehabilitative and habilitative services and devices – services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

To meet the standards set by the U.S. Department of Health and Human Services (HHS), all states must have a benchmark plan which will define the standard benefits that must be covered by plans in that state.

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