Essential Health Benefits

ERISA self-funded plans do not have to include 10 categories of benefits known as Essential Health Benefits (EHBs). However, if such self-funded plans do include EHBs for plan years beginning on or after Jan. 1, 2014, they are prohibited by PPACA from imposing lifetime or annual dollar limits on these benefits.

1. ambulatory patient services
2. emergency services
3. hospitalization
4. maternity and newborn services
5. mental health and substance abuse, including behavioral health treatment
6. prescription drugs
7. rehabilitative and habilitative* services and devices
8. laboratory service
9. prevention and wellness services and chronic disease management
10. pediatric services (including oral and vision care)