ESSENTIAL HEALTH BENEFITS (EHB)
Back to GlossaryDefinition
Ten categories of care that most non-grandfathered individual and small-group plans must cover, like hospitalization, drugs, and maternity care.
Summary
Essential Health Benefits (EHB) are ten mandatory categories of healthcare services that most health insurance plans must include under the Affordable Care Act. Think of them as the 'basic package' that ensures all insurance plans cover fundamental healthcare needs like doctor visits, emergency care, prescription drugs, and preventive services. These requirements prevent insurance companies from selling bare-bones plans that leave people without coverage for essential medical care.
Usage Context
Understanding EHBs is crucial when studying healthcare policy, insurance regulation, and the impact of the Affordable Care Act on coverage standards and consumer protection.
Common Confusions
- Thinking all health plans must cover EHBs (grandfathered and large group plans may be exempt)
- Confusing EHBs with preventive care requirements (EHBs are broader)
- Assuming EHBs mean free services (cost-sharing still applies)
- Believing EHBs standardize all benefits across plans (states have flexibility in defining specifics)
