004 Healthcare What? – Benefit Details

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Key Concepts

In Network
Out of Network
Deductible
Copay
Coinsurance
Out of Pocket Maximum
Lifetime Maximum

The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories:

  1. Ambulatory Patient Services
  2. Prescription Drugs
  3. Emergency Care
  4. Behavioral Health Services
  5. Hospitalization
  6. Rehabilitative and Habilitative Services
  7. Preventive and Wellness Services
  8. Laboratory Services
  9. Pediatric Care
  10. Maternity and Newborn Care

Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.

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