State RegulationsTX specificDifficulty 1/5
Under the essential health benefits provisions of the federal health care reform law, which of the following is a category of benefits that must be covered?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
ACA Sections 1302 and 18022 define essential health benefits by category, and mental health and substance use disorder services, including behavioral health treatment, is one of those categories, alongside pediatric services and preventive services. Adult dental coverage, cosmetic procedures and long-term custodial nursing home care are not essential health benefit categories, so a Texas agent cannot promise marketplace applicants that those items are required covered benefits.
Why the other options are wrong
- A) Adult dental care is not one of the essential health benefit categories, though pediatric dental services are part of pediatric coverage.
- B) Long-term custodial care in a nursing home is not an essential health benefit category.
- C) Cosmetic and other non-medically-necessary procedures are not essential health benefits.
Memory hook
Essential health benefits go by category - behavioral health is in, adult dental is not.