Essential Health Benefits (EHBs)

by  Wyn Staheli, Director of Content - innoviHealth
Sep 11th, 2015

The Patient Protection and Affordable Care Act (PPACA) - also known as Obamacare - mandated that certain services must be offered by health insurance plans. In other words, it sets a federal minimum level of coverage or benefits. These services are called Essential Health Benefits (EHBs).

Note: EHBs are the federal minimum standard. States also have their own minimum standards.

These are the 10 federal EHBs:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health services and addiction treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

These federal EHBs apply to all major medical plans sold on the Health Insurance Marketplace, small group plans, and Government programs such as Medicaid and Medicare.

Even though it is required to have coverage for these services, the amounts of coverage vary from plan to plan. For example, they may have hospitalization services, but only for a specifically contracted hospital.

See also the "Insurance and Reimbursement" chapter/section of your specialty specific DeskBook for additional information.