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What are “Essential Benefits” and How Do They Fit Into the Healthcare Reform Law?

A large part of the Affordable Care Act healthcare reform is to mandate preventive care coverage under all health insurance plans. The new law has incorporated various aspects of these treatments, known as essential benefits.

Consistency in various plans will help those who are getting coverage through health insurance exchanges to get the same kind of opportunities and offerings for those individuals who have healthcare coverage through an employer. In addition to ensuring that some core services are included in the plan, essential benefits extend some mental health services to individuals with gaps in their plan (as well as those with no health insurance plan at all).

In order to make sure that all healthcare plans are being measured accurately, states must select a “benchmark” plan that will be used to align services in other plans. As a result of that chosen benchmark, insurers will be required to use the example plan as a reference point.

The Department of Health and Human Services has issued a list of 10 categories where services must be included and explained within all healthcare plans. The list includes:

  • prescription drugs
  • laboratory services
  • emergency services
  • hospitalization
  • ambulatory services
  • maternity and newborn care
  • mental health treatment
  • preventive and wellness services
  • pediatric services – including oral and vision care.

To compare the various available plans and determine the best fit for you and your family, speak with an insurance agent. Agents are experienced in comparing plans and determining which premium, co-pay, and deductible lineups are the best for your needs.