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The Exchanges Provide Essential Health Benefits in 2014

The state Health Insurance Exchanges, an integral part of the ACA, are scheduled to be available for enrollment in late 2013, with an effective date of January 2014. So far, a small number of states have elected to establish their own exchanges, whereas most states have said that they aren’t interested. The federal government has indicated that it will offer a national plan.  While it remains to be see whether these exchanges will be ready to accept members, Health and Human Services (HHS) has published a proposed list of Essential Health Benefits (EHB) that all plans will be required to include. The EHB hopes to establish a consistency among plans so  that individuals and small business owners can compare features when looking at health insurance.

EHB consists of 10 categories of services:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral and 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


EHB also applies to plans that are outside the exchanges.

Undoubtedly, the EHB in addition to other features of new plans, will help individuals and small business owners understand new benefits of post ACA health insurance. We can only hope that there will be health insurance exchanges by 2014.

For additional information, contact EAB HealthWorks.