Which service is NOT one of the ten categories of essential health benefits (EHBs) 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 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 and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care. Custodial long-term care is deliberately absent from the list. It remains the province of long-term care insurance and, after spend-down of assets, Medi-Cal. Recognizing what is inside and outside the EHB list is a direct exam skill.
Why the other options are wrong
- B) Prescription drugs are an express EHB category, so this option is a required benefit rather than an exclusion.
- C) Maternity and newborn care is one of the ten EHB categories, so this option names a benefit the law mandates.
- D) Preventive and wellness services and chronic disease management are expressly included in the EHB list, so this option is also a required category.
Memory hook
EHBs treat diseases and keep you well; they do not bathe, dress, and feed you. Custodial care is out.