Essential Benefits

What Does Essential Benefits Mean?

Essential benefits refer to insurance coverage that meets standards set by the government for insurers. These are mandatory policy features required by law and must be included in any insurance product sold.

Insuranceopedia Explains Essential Benefits

Essential benefits were a key feature of President Obama’s Affordable Care Act. Under the ACA, ten services are considered essential benefits that must be covered by health insurance policies:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services
6. Prescription drugs
7. Rehabilitative and habilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services