Essential Health Benefits (EHB)
Different plans pay for a variety of services and diagnoses. Some plans may only cover inpatient care and outpatient care. Depending on your plan, other services such as hospital day care, home-based care, and respite care may be covered.
As part of the Affordable Care Act (ACA), no patient can be denied coverage for a pre-existing condition. In addition, no insurance plan can be canceled, except for in cases of fraud.
10 Essential Health Benefits
All health plans purchased through a health insurance marketplace or in the individual and small-group markets must cover 10 ‘essential health benefits’ (EHB).
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services (including behavioral health treatment)
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services (including oral and vision care)
Note: Particular services offered within the broad EHB categories vary significantly from state to state. Check your state for specifics.
- Last Updated
- American Academy of Pediatrics (Copyright © 2013)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.