Essential health benefits
Services that small group plans must cover
Essential health benefits are categories of health care services that must be covered by all non-transitional small group qualified health plans.
EHBs are determined on a state-by-state basis. Michigan’s EHB categories are:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Laboratory services
- Maternity and newborn care
- Mental health and substance use disorder services
- Pediatric services, including oral and vision care
- Prescription drugs
- Preventive and wellness services and chronic disease management
- Rehabilitative and habilitative services and devices
Are all employers required to provide EHBs to their employees?
No. Large groups with fully insured, self-funded and grandfathered plans are not required to cover EHBs.
What is a qualified health plan?
QHPs are Affordable Care Act-compliant plans that, in addition to covering EHBs, must follow established limits on cost-sharing. They are grouped into metal tiers based on the percentage of health care costs the plans cover.