The Ten Essential Benefits
One of the most defining points of the Affordable Care Act was that in order to be considered a “qualified health plan,” a plan has offer a comprehensive package of items and services, known as Essential Health Benefits. Qualified Health Plans are required for every individual and family who wishes to avoid the tax penalty for not having health coverage. There are ten of these essential health benefits required in a Qualified Health Plan, including:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital);
- Emergency services;
- Hospitalization (such as surgery);
- Maternity and newborn care (care before and after your baby is born);
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy);
- Prescription drugs;
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills);
- Laboratory services;
- Preventative wellness services and chronic disease management; and
- Pediatric services;
Many plans may offer additional coverage that just these ten benefits, but these are the ones required in order to avoid the penalty for not having proper health insurance.
Looking for a Qualified Health Plan? You will need a Qualifying Life Event to trigger a Special Enrollment Period if it’s outside of Open Enrollment (begins again November 15, 2014).
We can help you find out if you qualify! You can get an insurance rate quote here! If you have any questions, need help, or just prefer to speak with someone, feel free to call us at 1-877-279-7959.