What are Essential Benefits?
The ACA provided for 10 statutory essential health benefit categories. Benefits and services not included in the definition of essential benefits will not be included in the actuarial value calculation under the ACA.
The 10 Essential Benefit categories are:
- Ambulatory patient services
- Emergency Services
- Maternity and Newborn care
- Mental health and Substance abuse disorder services
- Prescription Drugs
- Rehabilitative and Habilitative services and devices
- Laboratory services
- Preventive and Wellness and Chronic Disease Management
- Pediatric services including oral and vision care