The 10 Essential Benefits Every Health Insurance Plan Must Provide

Updated: Jun 16, 2020




The Affordable Care Act made covering certain health care services a requirement for all Health Insurance plans available to consumers. These required services are known as the 10 Essential Benefits. These 10 categories of services are:


  • Ambulatory patient services (outpatient care that you can receive without being admitted to a hospital)

  • Emergency Services

  • Hospitalization for surgery, overnight stays, and other conditions

  • Pregnancy, maternity, and newborn care

  • Mental health and substance use disorder services

  • Prescription Services

  • Rehabilitative and habilitative services and devices (treatment and devices that help people gain or recover mental and physical skills after an injury, disability, or onset of a chronic condition)

  • Laboratory services

  • Preventive and wellness services, as well as chronic disease management

  • Pediatric services, including dental and vision coverage for children


These are categories of services; the specific services offered within these categories may vary from state to state. For the most part, states require that plans offer more services to their customers, rather than restricting services that an insured would expect within these categories. State, Federal, and private exchanges will list exactly which services each plan covers before you apply for insurance.


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