The Patient Protection and Affordable Care Act (the Act) enacted a series of insurance market reforms that impose new rules on health insurance issuers and group health plans. Commencing in 2014, the Act requires that polices of health insurance offered in the individual and small group markets as well as Medicaid benchmark plans offer a comprehensive package of items and services known as “essential health benefits” (EHB). Essential health benefits must include items and services within at least the following 10 categories: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care. Self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered health plans are not required to provide essential health benefits.

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This entry was posted by cmonfils on Tuesday, January 10th, 2012 at 8:07 pm and is filed under Health Care Legislation, Health Insurance, HHS, PPACA. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.