“Essential Health Benefits” in Qualified Health Plans

Important:  The Coronavirus Response Act has included the testing, diagnosis and treatment of COVID-19 in the list of “Essential Health Benefits” in federally-qualified health plans. 

Most preventive care is “free” (no deductible) under qualified individual major medical insurance plans.  These plans are available to you through the U-Haul Dealer Benefits Program on our national private health exchange during federal enrollment periods and meet both your state and federal requirements.

There are 22 preventive-care services provided specifically for women, listed by the editors of Health, including mammograms, cervical cancer screenings and well-woman visits.  Other covered preventive care services include blood pressure, diabetes, depression and cholesterol screenings for adults, and vaccines and well visits for children.  You pay nothing for these services – no deductible, copay or coinsurance under qualified individual medical plans.

Knowing preventive care is covered outside your plan’s deductible makes it more acceptable for most people to select a plan with a higher deductible to get your monthly premium cost down.

All qualified medical insurance plans include a package of essential benefits mandated by federal rules, over and above the existing benefit requirements of each state.  Health insurers have revised their health plans and refiled them with state insurance authorities to include these new “Essential Health Benefits.”

All of the following benefit categories are now covered.  Depending on the plan design you select, deductibles, copays and coinsurance still apply to all but preventive care.

1. Preventative and wellness

Testing, diagnosis and treatment of COVID-19, routine physicals, screening, immunizations, and disease management are covered with no out-of-pocket cost.  ACA health plans are required to cover these preventative and wellness services without cost-sharing (no co-pay, coinsurance or deductible charges).   To further address health needs specific to women, in December 2021, the federal Health Resources & Services Administration approved a new guideline on obesity prevention for midlife women and updates to five existing preventive services guidelines: Well-Women Preventive Visits, Breastfeeding Services and Supplies, Counseling for Sexually Transmitted Infections (STIs), Screening for Human Immunodeficiency Virus (HIV) Infection, and Contraception.  For details, see HRSA.gov/womens-guidelines.

2. Ambulatory or outpatient services

Care you receive without being admitted to a hospital, such as at a clinic, physician’s office, or day surgery center.

3. Prescription drugs

Drugs prescribed by a doctor to treat acute illnesses and ongoing conditions.

4. Laboratory services

Testing of blood and tissues ordered by a doctor to diagnose and monitor medical conditions.

5. Pediatric services

All the above essential benefits as provided to children, including oral and vision care. Single people and childless families get this coverage too.

6. Emergency services

Care for conditions which, if not treated immediately, could lead to serious disability or death.

7. Maternity and newborn

Care for women during pregnancy and labor and for newborn children. Bachelors get this coverage too.

8. Rehabilitative services

Services and devices to help with injuries, disabilities, chronic conditions, recover mental and physical skills.

9. Hospitalization

Care you receive as an inpatient, including room & board, doctor and nurse care, administered tests and drugs.

10. Mental health, substance abuse and behavioral health treatment

Care to evaluate, diagnose, and treat.