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Essential Health Benefits

Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB).

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:

  • These essential health benefits include at least the following items and services:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services including oral and vision care

According to the Affordable Care Act, plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.

Footnote: This is a brief overview of Essential Health Benefits required by the Affordable Care Act. You should read thoroughly and understand the benefits offered before purchasing any insurance policy.

Major Medical
  • Understanding Your Health Insurance Options
  • Health Insurance Plans Available on the Marketplace
  • Essential Health Benefits
  • Summary of Benefits and Coverage
  • Understanding the Affordable Care Act
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Please Tap on the FMIG logo above for an Major Medical Insurance Quote

The link above will take you to Brent Jenkins and his amazing staff. They will reach out to you within 24 hours. Just fill out your name, telephone number, and Zip. I use FMIG for my family's major medical myself.

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Local Agent. Complicated Questions? Great Advice.

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Local Agent in East Tennessee with 18 years of helping people. Worked as an employee of a major insurance company for 14 years then was offered a position as an independent insurance agent. I have been married for 25 years and have adult children and grandbabies. Would love to help you with your insurance questions and needs.

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Knoxville
Tennessee
37923
(865) 640-8175

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Important disclosures about Medicare Plans: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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