Essential health benefits
Services that small group plans must cover
Essential health benefits (EHB) 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 (QHP)?
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.
