Which of the following is a category of essential health benefits that the Affordable Care Act requires to be covered in individual and small-group health plans?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under the Affordable Care Act, individual and small-group health plans must cover a core package of essential health benefits, and maternity and newborn care is one of the required categories, alongside emergency services, hospitalization, prescription drugs, mental health and substance use disorder treatment, laboratory services, and pediatric oral and vision care. The package exists so these fundamental services cannot be omitted from the policies New York consumers buy. The New York State Department of Financial Services oversees the plans New York insurers offer under these federal requirements.
Why the other options are wrong
- A) Cosmetic surgery performed solely for aesthetic reasons is not an essential health benefit, and plans need not cover it.
- C) Only pediatric oral and vision care belongs to the essential health benefits; routine dental and vision care for adults is not a required category.
- D) Long-term custodial nursing home care is not an essential health benefit; custodial long-term care is a separate product from major medical coverage.
Memory hook
Maternity is essential; adult dental and custodial care are not.