· Ambulatory patient services (outpatient care – no hospital admittance)
· Emergency room services
· Pregnancy, maternity, and newborn care(both before and after birth)
· Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
· Prescription drugs
· Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
· Laboratory and testing services
· Preventive and wellness services and chronic disease management
· Pediatric services, including oral and vision care ( adult dental and vision coverage aren’t essential health benefits, plans may or may not include them)
Plans must also include the following benefits:
· Birth control coverage
· Breastfeeding coverage
Essential health benefits are minimum requirementsfor Federal / State Marketplace plans. Specific services covered in each benefit category can vary based on each state’s requirements. Plans may offer additional benefits, including:
· Dental coverage
· Vision coverage
· Medical management programs (for specific needs like weight management, back pain, and diabetes)
Plans are labeled ‘Metal tier’ plans – Bronze, Silver, Gold and Platinum.
Coverage benefit levels are offered as follows:
· Bronze = 60 percent coverage coverage with respect to essential benefits
· Silver = 70 percent coverage with respect to essential benefits
· Gold = 80 percent coverage with respect to essential benefits
· Platinum = 90 percent coverage with respect to essential benefits
As a Certifed Agent / Agency for Obamacare plans including Covered CA, we can assist you to compare out the specific plans for your situation, and find the best rates and assistance for you from the quotes generated. There is no additional cost for this service.
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