One of the major features of the Affordable Care Act (ACA) was the requirement that all insurance plans must offer the ten Essential Health Benefits (EHBs). But, what are those benefits and how do they differ from benefits before the law was passed.
I use a mnemonic to help remember what the 10 EHBs are: “PROM HELD on WEB”
| Initial | Keyword | Benefit |
| P | Prescriptions | prescription drugs |
| R | Rehab | rehabilitative and habilitative services and devices |
| O | Outpatient | ambulatory patient services; |
| M | Mental | mental health and substance use disorder services, including behavioral health treatment |
| H | Hospital | hospitalization |
| E | Emergencies | emergency services |
| L | Lab | laboratory services |
| D | Dental for kids | pediatric services, including oral and vision care |
| on | ||
| W | Wellness | preventive and wellness services and chronic disease management |
| E | ||
| B | Babies | maternity and newborn care |
When you are thinking about enrolling in a health insurance plan, be sure you know whether the plan is a “compliant plan” under the ACA. If so, it will include each of these benefits—even if some don’t specifically apply to you individually.
There may be situations where you choose to enroll in a noncompliant plan—such as when you have the need for short-term medical insurance as a bridge between standard plans. Just be sure you know what you are buying and why.
As independent brokers, we are able to compare prices and benefits among all insurance providers. If you are confused or just want help making choices, give us a call.
