Required Benefits

The following ten essential health benefits must be included in all major medical insurance plans sold on the individual and small group markets:

  1. Ambulatory Patient Services
  2. Emergency Services
  3. Hospitalization
  4. Laboratory Services
  5. Maternity and Newborn Care
  6. Mental Health & Substance Use Disorder Services
  7. Pediatric Services, Including Dental and Vision
  8. Prescription Drugs
  9. Preventive, Wellness Services, and Chronic Disease Management
  10. Rehabilitative and Habilitative Services and Devices

Preventive services:  Individuals do not pay co-pays, coinsurance or deductibles for certain preventive health services that are provided by network providers, including routine immunizations and routine physical exams, such as:  gynecological exams, digital rectal exams, pediatric eye exams, mammograms, and routine colorectal cancer screenings. 

Important Reminder: Talk with your provider about whether these procedures are considered routine or diagnostic in your specific case.  You will have to pay a portion of diagnostic exams or procedures.