WPS Health Insurance Blog

New health plans must include essential health benefits

Posted by Ryan Kanable

Oct 8, 2013 9:00:00 AM

Essential health benefitsToday, most health plans have limits on how much coverage you get. In 2014, that will no longer be the case for essential health benefits. The Affordable Care Act (ACA) requires your plan to cover your costs for essential health benefits so that you’ll have the coverage you need. This applies to individual insurance and group insurance that you get either on your own or through your employer.

Essential health benefits include items and services within at least the following 10 categories:

  • 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.

One provision that went into effect on Sept. 23, 2010, eliminates lifetime limits on coverage. Any new policy issued after that date is considered not grandfathered and cannot have a lifetime limit. Also, beginning Jan. 1, 2014, annual limits are eliminated as well.

Keep in mind, though, that health plans can still impose annual and lifetime limits on coverage that isn’t considered “essential,” such as acupuncture and some chiropractic treatments, depending on which state you live in. And while plans cannot put limits on the dollar amounts, there may be limits on how many office visits are covered.

To find out more about essential health benefits and other ACA-related topics, take a look at our new Health Care Reform Information Center, our Learning Center, or check out our free brochure, 9 Things You Need to Know About the Affordable Care Act.

Topics: health insurance