What's covered under health insurance
Most health insurance plans must cover certain benefits as required by state and federal law. These are called mandated health benefits. In addition, most health plans offer additional optional health benefits. We recommend you refer to the policy for specifics.
Preventive services under health reform
Most health plans must cover preventive services with no cost-sharing (www.healthcare.gov). This means you won't pay a copay or coinsurance for certain medical services, such as immunizations and blood pressure screening.
Essential health benefits under health reform
All individual and small employer health plans must include the following 10 categories of essential health benefits:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and treatment of substance abuse disorders, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Most health plans are not allowed to have annual benefit limits and none are allowed to have lifetime benefit limits.
Summary of benefits and coverage
Today, every health insurer must give you a summary of the plan's benefits and coverage (www.healthcare.gov) as well as a glossary of commonly used terms before you enroll and each year when your plan renews. These documents explain your benefits and coverage limits in clear, easy-to-understand language.