WPS Health Insurance Blog

Essential health benefits no longer limited in 2014

Posted by Ryan Kanable

Mar 5, 2013 9:00:00 AM

HealthyHealth care reform is bringing many changes to the market. One of them affects the basic coverage everyone will get. Today, insurance companies can place limits on how much coverage you get. By 2014, that will no longer be the case for essential health benefits. If you’re sick and you have insurance, you’re covered!

The Affordable Care Act (ACA) requires your insurance company to cover your costs for essential health benefits so that you’re never cut off. This applies to individual insurance and group insurance that you get either on your own or through your employer.

What are essential health benefits?

Essential health benefits include items and services within at least the following 10 categories, according to www.healthcare.gov:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • 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.

Limits are being removed

One provision that went into effect on Sept. 23, 2010 eliminates lifetime limits on coverage. Policies issued before that date are considered grandfathered. Policies issued after that date may have an annual limit, but these limits are being phased out over a period of years. See the chart below.

 Time period

 Annual limit

 On or after Sept. 23, 2010 but before Sept. 23, 2011


 On or after Sept. 23, 2011 but before Sept. 23, 2012

 $1.25 million

 On or after Sept. 23, 2012 but before Jan. 1, 2014

 $2 million

 Beginning Jan. 1, 2014


Keep in mind, though, that insurance companies can still impose annual and lifetime limits on coverage for services that aren’t considered “essential,” such as acupuncture and some chiropractic treatments, depending on which state you live in. And while insurers cannot put limits on the dollar amounts, they may be able to limit how many office visits are covered.

Find out more about health care reform in our Learning Center.

Topics: health insurance