The following ten essential health benefits must be included in all major medical insurance plans sold on the individual and small group markets:
- Ambulatory Patient Services
- Emergency Services
- Laboratory Services
- Maternity and Newborn Care
- Mental Health & Substance Use Disorder Services
- Pediatric Services, Including Dental and Vision
- Prescription Drugs
- Preventive, Wellness Services, and Chronic Disease Management
- Rehabilitative and Habilitative Services and Devices
Preventive services: Individuals do not pay co-pays, coinsurance or deductibles for certain preventive health services that are provided by network providers, including routine immunizations and routine physical exams, such as: gynecological exams, digital rectal exams, pediatric eye exams, mammograms, and routine colorectal cancer screenings.
Important Reminder: Talk with your provider about whether these procedures are considered routine or diagnostic in your specific case. You will have to pay a portion of diagnostic exams or procedures.