Colorado EHB Benchmark Requirement List.
The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
In addition to the basic EHB benefit categories, Colorado has the following state-required benefits:
- Congenital defects and birth abnormalities
- Maternity coverage
- Biologically Based mental Illness
- Mental illness
- Applied behavior analysis based therapies and other treatment services
- Prosthetic devices
- Hearing aids for children
- Cervical cancer vaccination
- Preventive services (including immunizations for children up to age 13)
- Contraception
- Prostate cancer screening
- Rehabilitative speech therapy
- Clinical trials and studies
- Diabetes
- Inherited Enzymatic Disorder
- Off-label use of cancer drugs
- Hospitalizations and general anesthesia for dental procedures for dependent children
- Oral anticancer medication
- Cleft lip and cleft palate
- Early intervention services
- Rehabilitative occupational therapy
- Rehabilitative physical therapy
Certain limitations and exclusions apply.