Health Care Reform and You

Affordable Care Act is changing the way some Americans get health insurance. We make it easy to learn, shop, and enroll.

One of the ways it has changed is with health care reform, fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits beginning January 1, 2014. 

Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services (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

Reform says that plans of all sizes that cover benefits designated as Essential Health Benefits, including self-funded plans, must cover these benefits with no annual limits or lifetime maximums.

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