Essential Health Benefits

All ACA Health Plans must include a comprehensive package of items and services, known as Essential Health Benefits.

Essential Health Benefits must include items and services within at least the following 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drug benefits
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services, including oral and vision care.
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