How your Insurance Plan will look in 2014

The Affordable Care Act (ACA) requires that non-grandfathered health insurance plans offered in the individual and small group markets (both inside and outside of the Exchanges) provide a  package of health care services, known as “Essential Health Benefits” (EHB). More specifically, we use the term “10 Essential Health Benefits” in order to prevent confusion with other ACA madates.


This rule is intended to standardize plan offerings and enhance consumers’ ability to compare and make informed choices about health plan purchases.


The 10 Essential Health Benefits under the Patient Protection and Affordable Care Act will include the following general categories:



  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse 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


What else is important about the 10 Essential Health Benefits? Individual and small group plans must cover these benefits with no annual limits or lifetime maximums.

Under the ACA, plans of all sizes (for instance, large employer plans),  including self-funded plans, that choose to cover benefits designated as  the 10 Essential Health Benefits, must also cover these benefits with no annual limits or lifetime maximums.

Your agent can provide information about the 10 Essential Health Benefits standardized in your state. If you are an employer, you will want to consider how the rules of Essential Health Benefits affect the coverage offered to your workforce.


Patient Protection & Affordable Care Act (PPACA) information discussed in communications is most accurate as of this date. The Department of Health & Human Services may amend or change federal regulations at any time.