Which of the following is NOT one of the ten essential health benefits (EHB) categories required in non-grandfathered individual and small group plans?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The ACA's essential health benefits package spans ten statutory categories, including 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 pediatric services including oral and vision care. Cosmetic surgery is not among the EHB categories; it is generally treated as a non-covered elective service or an optional benefit. A plan certified as a qualified health plan must cover the EHB package, which is why cosmetic procedures sit outside the required scope.
Why the other options are wrong
- B) Emergency services are an explicit EHB category, covering emergency care including out-of-network emergency services.
- C) Prescription drugs are an explicit EHB category that requires the plan to cover a formulary of drugs.
- D) Maternity and newborn care is an explicit EHB category, covering prenatal, delivery, and newborn services.
Memory hook
EHB's ten categories heal and prevent; cosmetic work never makes the essential list.