Which of the following is among the ten essential health benefit (EHB) categories that QHPs must cover?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The ten EHB categories are ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. Plans in the individual and small-group markets must cover all ten categories. Long-term care, cosmetic surgery, and comprehensive adult dental and vision are not EHB categories. The ten essential health benefit categories establish the floor of coverage that QHPs in the individual and small-group markets must provide. The list is designed around comprehensive, acute-care needs of families, which is why maternity and newborn care appear explicitly and why services such as cosmetic surgery or adult custodial care do not.
Why the other options are wrong
- B) Long-term care is not an EHB category; custodial care is generally excluded from health coverage. Long-term care services are not one of the ten essential health benefit categories; the EHB floor centers on acute and primary care.
- C) Cosmetic surgery is typically excluded and is not one of the ten EHB categories. Cosmetic surgery is not a required EHB and is routinely excluded from QHP coverage as a non-essential service.
- D) EHB pediatric services require limited pediatric dental and vision; comprehensive adult dental and vision is not an EHB. Pediatric oral and vision care are included through the pediatric services category, but comprehensive adult dental and vision are not required EHBs.
Memory hook
Ten EHB boxes to check: hospital, doctor, drugs, maternity, mental health, rehab, lab, preventive, peds, emergency.