Which of the following is one of the essential health benefits (EHB) categories that individual and small group plans must cover?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The Affordable Care Act requires individual and small group plans to cover the ten categories of essential health benefits, which include hospitalization, ambulatory patient services, emergency services, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services including oral and vision. Hospitalization is a core EHB category, while cosmetic surgery, custodial care, and adult dental are not among the mandated categories. Plans must also meet the actuarial value standard of the metal tier they select, so the EHB list is combined with cost-sharing rules to define the required scope of coverage.
Why the other options are wrong
- B) Cosmetic surgery is not an essential health benefit; it is typically an excluded or limited service in health plans.
- C) Long-term custodial care is not an EHB category and is generally not covered by medical expense policies.
- D) Adult dental implants are not required as an EHB; pediatric oral services are the mandated dental component.
Memory hook
EHB = ten boxes you must tick, and hospitalization sits right on the top shelf.