Essential Health Benefits

October 23, 2013 Ryan Schuster

Essential Health Benefits are a set of health care services that are required by the Affordable Care Act to be covered by certain health plans beginning in 2014.

All non-grandfathered individual and small employer plans offered both off and on public online exchanges must include Essential Health Benefits coverage beginning in 2014. All Medicaid state insurance plans are also required to cover Essential Health Benefits in 2014.

SOURCE: America's Health Insurance Plans

Insurers selling those plans are required to provide coverage in each of the 10 categories, with specific services for 2014 and 2015 defined in North Dakota by the Essential Health Benefits benchmark plan:

  • Outpatient care (care received that doesn't require being admitted to a hospital)
  • Hospital stays (also referred to as inpatient care)
  • Emergency care
  • Maternity and newborn care
  • Preventive and wellness services
  • Physical therapy
  • Prescription drug coverage
  • Laboratory services
  • Dental and vision care for children.

To learn more, visit our health care reform site at