What Are Essential Health Benefits?

With the Affordable Care Act, a new term has entered the health care world: essential health benefits. The term refers to a core set of benefits that every health plan in a state is encouraged to offer.  The benefits are determined by choosing one plan in a state, and using.the services covered by that plan serve as a benchmark.

In Colorado, essential benefits are based on Kaiser Health Plan’s HMO. Services include: 

  • Outpatient (or Ambulatory) patient care
  • Emergency Medical Care
  • Hospital care
  • Maternity care
  • Infant care
  • Behavioral health, mental health and substance use counseling and treatment
  • Prescription medicines
  • Rehabilitation therapy, physical therapy and occupational therapy
  • Medical tests
  • Wellness counseling and annual physicals
  • Chronic disease management
  • Dental and vision care for children

Essential health benefits help to assure Colorado residents that their health plans are comparable to any other plans in the state. The concept encourages health plans to compete on cost and services, while providing comprehensive health coverage to members. Since benchmark plans exist within each state, coverage can reflect the specific demographics and health status of the state.

Pilkington Financial Services can help you plan for all your insurance needs. To learn more, contact us.