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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).

  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
  10. 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.
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