This year the federal government issued final regulations to set “essential health benefits” for individual and small group health plans operating under the Patient Protection and Affordable Care Act.
The regulations take effect Jan. 1, 2014, and individual and small group health plans must provide the specified benefits after that date. Revised regulations for large groups and employer-sponsored health plans will be issued later and are likely to be similar in the nature of services that are covered.
1. Ambulatory patient services
2. Emergency services
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