Essential Health Benefits

HHS Releases Final Regulations on Essential Health Benefits

To achieve the goal of quality coverage, the Affordable Care Act has established a set of benefit requirements for individual and small group plans.  As a result, no matter what plan you choose, you will be confident that your basic healthcare needs will be met.  These benefits we refer to as Essential Health Benefits or EHB.  Under the statute, EHB must include items and services within the following 10 categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness including chronic disease management
10. Pediatric services, including oral and vision care

In addition to these services, every plan must cover what the "typical" employer plan covers in each state referred to as the "benchmark" plan.  Each state needed to submit their benchmark plan for review. Illinois selected a Blue Cross and Blue Shield of Illinois plan as their benchmark plan because it is the most common small group plan in the state.  The plan does not cover all of the EHB's, specifically the dental and vision care for children.  The plan is supplemented by the All Kids dental and Federal Vision to make it compliant with the law.  To see what the Illinois benchmark plan covers you can review it here.  

For additional information visit Fact Sheet on Essential Health Benefits

The Rockwood Company - Insurance Brokers since 1896 - To find out more about healthcare reform and how it affects your business, please feel free to contact us at ddoe@rockwoodco.com or 312-621-2215.