Essential Benefits

What Does Essential Benefits Mean?

Essential benefits refer to insurance coverage that meets standards set by the government for insurers. These are policy features that are mandated by law and must be present in any insurance sold product sold.


Insuranceopedia Explains Essential Benefits

Essential benefits were one of the important features of President Obama's Affordable Care Act. Under the ADA, ten things are considered essential benefits that must be covered by health insurance policies:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services
  • Prevent and wellness services
  • Pediatric services

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