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Essential Health Benefits

All metallic plans (Gold, Silver, Bronze) include 10 essential health benefits:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

These essential health benefits must be covered with no annual or lifetime dollar limits. For example, preventive services, including women’s preventive care and birth control must be paid 100 percent by the health plan.

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