The health care law requires all health plans sold to individuals and small groups (in most states, groups with no more than 50 employees) to cover certain important health care services, known as "essential health benefits". While it requires coverage for each of these categories of benefits, the la does not name the specific services that must be covered or the amount, duration and scope of covered services.
Ambulatory Patient Services
Care you receive without being admitted to a hospital - for example, at a physician's office, clinic or same-day surgery center.
Drugs prescribed by a doctor to treat an acute illness, like an infection, or an ongoing condition, like high blood pressure.
Care for a sudden and serious condition, such as the symptoms of a heart attack or stroke. Under the health care law, emergency room visits do not require preauthorization, and you cannot be charged extra for an out-of-network visit.
Mental Health Services
Care to evaluate, diagnose and treat mental health and substance abuse issues. Many plans don't cover mental or behavioral health services, but that will change under the law. In some states, coverage may be limited to a set number of therapy visits per year.
Care you receive as a patient in a hospital, such as room and board, care from doctors and nurses, and tests and drugs administered during your impatient stay.