The Affordable Care Act (ACA) requires that all health insurance coverage for individuals and small groups includes certain treatments and procedures or “essential health benefits.”

The underlying idea is that the essential benefits package be equal to the coverage offered under a typical employer plan, with 10 general categories that include:

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