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Essential Health Benefits

Under the Affordable Care Act individual and small group health plans must cover these 10 essential health benefits:

  • Outpatient care you get without being admitted to a hospital, including doctor's office visits
  • 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 (examples: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation)
  • Lab tests
  • Preventive and wellness services and chronic disease management (examples: blood pressure and diabetes screenings, mammograms and colonoscopies, vaccinations and flu shots)
  • Pediatric services, including dental and vision care. (Plans must offer dental coverage for children, ether as a stand-alone dental plan or as part of a medical plan. Dental benefits for adults are optional.)

Some plans cover more services. You’ll see more about what each plan offers when you compare plans.

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