What are Essential Health Benefits?
Essential Health Benefits (EHBs) are categories of health care services that must be covered by all
non-grandfathered* small group (50 or less eligible employees) Qualified Health Plans (QHPs). QHPs are Affordable Care Act-compliant plans that, in addition to covering EHBs, must follow established limits, on cost-sharing. All QHPs are grouped in different metal levels – Platinum, Gold, Silver, Bronze – based on actuarial value, or the percentage of health care costs the plan covers.
EHBs are determined on a state-by-state basis, and at a minimum, they include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic and disease management
- Pediatric services, including dental and vision care
Are all employers required to provide EHBs to their employees?
Large group (51 or more eligible employees) fully insured, self-funded and grandfathered plans are not required to cover the 10 EHBs.