10 Essential Health Benefits
What are “Essential Health Benefits”? If your plan does not cover these services, it is not a “Qualified Health Plan”:
♦ Ambulatory patient services (clinics, doctors office, same-day surgery centers, etc.)
♦ Emergency services
♦ Hospitalization
♦ Maternity and newborn care
♦ Mental health and substance use 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
Dental for “Pediatrics” means anyone under the age of 19. Check the plan “Summary of Benefits” to see if a dental plan for children under the age of 19 is already built into the plan. ON Exchange pediatric dental is offered for purchase separately, OFF Exchange there may be a plan built into the health plan or not. You’ll need to look at the “Summary of Benefits” in your plan.
