Essential Benefits: What are they?

October 17, 2011

The essential benefits package will become the standard for health coverage and will be used as the basis for establishing the different benefit levels of plans that will be offered in the health insurance exchange. In addition, all new health plans that are sold to individuals will have to cover, at a minimum, all of the health care services in the essential benefits package. In 2014, all Small Group (1 to 100 Employees) will include these essential benefits as well. This will help ensure that every health plan provides the quality of coverage and financial protections necessary to safeguard families from the devastating financial effects of illness.

Right now, the Department of Health and Human Services (HHS) has come out with an estimation of what these benefits will be.  They are as follows:

  • Ambulatory Patient Care
  • Emergency Room Services
  • Hospitalization
  • Maternity & Newborn Coverage
  • Mental Health & Substance Abuse
  • Prescription Benefit
  • Rehab
  • Prevention & Wellness
  • Pediatrics Including Oral & Vision

There may be some more tweaks to this, but this is a solid estimation that you can pretty much take to the bank!

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Susan L. Combs

Susan L. Combs, founder and CEO of Combs & Company, is a visionary leader transforming the insurance industry with innovation, integrity, and a commitment to educating and empowering every client.

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