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If you have Health Insurance, you’re probably all too familiar with what your plan won’t cover. The list of expenses denied when you try to file a claim can seem endless. It’s easy to wonder what actually is covered.

This February, Americans got more clarity about what Health Plans must cover starting in January 2014, when the U.S. Department of Health and Human Services (HHS) published its list of ten “essential health benefits” under the Affordable Care Act (ACA). These categories apply to both individual and small employer insurance, as well as new plans under Medicaid.

Here are the mandatory categories of treatment and care:


    1. Outpatient medical care.


    1. Emergency care.


    1. Hospitalization.


    1. Maternity and Newborn care.


    1. Mental Health and Substance Use Disorder services.


    1. Prescription Drugs.


    1. Rehabilitation Services and Devices.


    1. Lab Tests.


    1. Preventative and Wellness services, and Chronic Disease Management.


    1. Pediatric Services, including Dental and Vision care.


In response to the release of the new standards, American Association of Health Insurance Plans spokesperson Robert Zirkelbach noted, “The minimum essential health benefits standard will still require many individuals and small businesses to purchase coverage that’s more comprehensive and more expensive than they choose to purchase today.”

This is all the more reason for people planning to buy coverage under the ACA to be well informed when the State Health Insurance exchanges open on October 1.

HHS offers an enrollment checklist for individuals, families, and small businesses that includes questions to ask about Health Plans, a primer on coverage basics, and guidelines for budgeting.

As always, our Tracy-Driscoll insurance specialists stand ready to offer their advice to help you select the best value for your Health Insurance dollar. Just give us a call at (860) 589-3434.