For Consumers

What's covered under health insurance

Most health insurance plans are required to cover or offer certain benefits. We recommend you refer to your policy for specifics.

Preventive services under health reform

Most health plans must cover preventive services with no cost-sharing ( This means you won't pay a copay or coinsurance for certain medical services, such as immunizations, tobacco cessation and blood pressure screening, as long as they're delivered by an in-network provider.

Essential health benefits under health reform

All individual and small employer health plans must include the following 10 categories of essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • 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 and chronic disease management
  • Pediatric services, including oral and vision care

Coverage limits

Most health plans are not allowed to have annual benefit limits and none are allowed to have lifetime benefit limits.

Summary of benefits and coverage

Today, every health insurer must give you a summary of the plan's benefits and coverage ( as well as a glossary of commonly used terms before you enroll and each year when your plan renews. These documents explain your benefits and coverage limits in clear, easy-to-understand language.