Essential Health Benefits


Purpose:

To assure that health plans offered in the individual or small employer group markets or Exchanges provide coverage for specific services


Intent:

To make more coverage available to a covered individual


Related Provision:

Cost-Sharing Limits
Minimum Value of Coverage


Health Plans Affected by this Provision:


Year Effective: 2014
Medical Plan: Yes, for individual or small employer plan, unless plan is Grandfathered, a plan in effect and without significantly changed coverage or premium share since March 23, 2010
Dental/Vision Plan: No, if stand-alone benefit excepted from HIPAA’s portability provisions
HRA: Yes, unless coverage is stand-alone dental or vision or for those enrolled in any part of Medicare
Health Care FSA: No, unless FSA is a non-excepted benefit

Document Downloads:


Document Title Last Updated
Essential Health Benefits Flyer  
Women's Preventive Care Benefits  
DOL Technical Release 2013-03 (HRAs)  
PHSA Essential Health Benefits  
CMS Fact Sheet  
HHS Benchmark Guide  
IRS FAQ, January, 2013 01/01/2013
Location (map)
1350 Deming Way, Ste 300
Middleton, WI 53562-4640

Mail Address
PO Box 44347
Madison, WI 53744-4347