ACA Facts: Essential Health Benefits

January 12, 2013

Essential Health Benefits

The essential health benefits (EHB) are a comprehensive set of items and services, established under the ACA. The law ensures that health plans offered in the individual and small group markets, both inside and outside of the exchanges, offer this all-inclusive and wide-ranging set of benefits by 2014. EHB must include, at a minimum, benefits within 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. In December, HHS issued a bulletin on the EHB to determine how to properly define the benefits. The disability community is following this process closely and many organizations, including the Consortium of Citizens with Disabilities (CCD), have submitted comments.