Essential Benefits Regulation Approved

Insurance Commissioner Dave Jones approved an emergency regulation requiring health insurers to cover all essential health benefits for new policies in effect after January 1, 2014. The emergency regulation is a critical element of Affordable Care Act implementation. The Affordable Care Act requires non-grandfathered health insurance policies in the individual and small group markets (inside and outside of the Health Benefits Exchange) to provide coverage for a comprehensive package of healthcare benefits, known as “essential health benefits.” In the past, some policies have included very limited or no coverage for important healthcare services. Plans must cover the following essential benefits in 2014:
1. Ambulatory patient services (outpatient 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 (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices.
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services, including oral and vision care

For more information, visit www.insurance.ca.gov.

Last Updated 09/23/2020

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