Affordable Care Act Essential Health Benefits

Beginning with policies issued January 1, 2014, for a health insurance plan to be considered a Qualified Health Plan (QHP) it must provide services in ten areas. These services are know as Essential Health Benefits (EHB). These ten categories are:

  • Doctor office visits
  • Hospitalization
  • Rehabilitative and Habilitative services and devices
  • Lab services such as blood work and x-rays
  • Emergency room services
  • Maternity (pregnancy and delivery) and newborn care
  • Prescription drug coverage
  • Mental health and substance abuse treatment
  • Preventive and wellness benefits
  • Pediatric Services including Pediatric Dental and Vision

Qualified Health Plan (QHP)

A health insurance plan must provide the ten categories of services listed above to be certified a Qualified Health Plan (QHP) under the Affordable Care Act. Only Qualified Health Plans are sold on the Health Insurance Marketplace. Any Qualified Health Plan sold on the Marketplace is available off Marketplace.