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2014 Plans to Require “Essential Health Benefits”

2014 Plans to Require "Essential Health Benefits"July 15th, 2013 – Most people know that starting on January 1st, 2014 the Affordable Care Act (ACA) requires that health insurance companies must provide insurance to people regardless of any pre-existing health conditions. However, the ACA has some additional requirements that will shape what those new health insurance policies will look like.

Starting on January 1st, 2014 all new individual and employer sponsored health insurance plans must cover certain “essential benefits.”

Here are 10 categories of essential health benefits that must be included in all new plans starting in 2014:

  1. Outpatient services
  2. Emergency services
  3. Hospital stays
  4. Maternity and newborn care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitation services and devices like durable medical equipment and prosthetics
  8. Lab services
  9. Preventive and wellness services and, long-term disease management
  10. Pediatric services, including dental and vision care

While many of these benefits were already in most health plans, many plans had fairly weak coverage for mental health or pediatric dental and vision care, so these services along with the fact that health insurance will be guarantee issue are expected to help contribute to more expensive plans starting in 2014.

Timing wise, these essential health benefits must be included in all plans for individuals and small businesses on the first day of the plan year on or after January 1, 2014. However, the requirement does not apply to grandfathered plans or plans for large businesses.

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