Upon request, the Affordable Care Act (ACA) requires every health insurance company to give you a Summary of Benefits and Coverage (www.healthcare.gov) that explains your benefits and coverage limits in clear, easy-to-understand language. Although some health plans offer additional benefits, plans are required by state and federal laws to provide certain benefits:
Preventive services without cost-sharing (www.healthcare.gov) - For your health plan to provide you with preventive benefits, your in-network medical provider will need to bill your treatment as a preventive service.
Note: Essential health benefits apply only to individual and family/small-group plans.
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and treatment of substance abuse disorders, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services, including chronic disease management
- Pediatric services, including oral and vision care