The Affordable Health Care Act Explained: Part 2b – Essential Benefits

As we stated in the previous part of this series, Title I of the Affordable Health Care Act eliminates lifetime limits and annual limits to benefits.  The later is phased in through January 1, 2014 and includes only “essential” benefits.  This is important information for all Medical Billing professionals.

So what benefits are deemed essential under the Act?

Glad you asked.  Here they are as listed by category:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, 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

Remember, however, that grandfathered plans are not included in this list of essential benefits. Grandfathered plans are those plans that an individual has privately purchased or renewed prior to September 23, 2010.  Also, this exception only applies to the Annual limits, not the lifetime.  The elimination of lifetime limits in the Affordable Health Care Act applies to all.

We hope you find this list useful in serving your Medical Billing clients.

In the Next part, we shall consider the next part of Title I, Prohibition on Rescissions (sec. 2712).

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