Colorado Essential Health Benefits

States are allowed flexibility when selecting their EHB-benchmark plan. This page will detail your state’s specific selections.

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.