Essential Health Benefits

Under the Affordable Care Act all insurance must cover certain basic services known as Essential Health Benefits:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral
health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management, and
10.Pediatric services, including oral and vision care

2014 – 2015

For the first two years of Exchange operation (2014 and 2015), each state will have its own set of Essential Health Benefits, a specific “benchmark” plan chosen by the state, selected from plans offered in the state during the first quarter of 2012.

New Hampshire’s Joint Health Reform Oversight Committee has selected the Matthew Thornton Blue (Anthem Blue Cross/Blue Shield) plan as the Essential Health Benefit benchmark for New Hampshire.  This means all insurance plans must cover the services covered by Matthew Thornton Blue, or equivalent services with the same actuarial value. However, other insurance plans are not required to adopt the same cost-sharing features as the Matthew Thornton Blue plan.

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