Utah Essential Health Benefits

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

Utah 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, Utah has the following state-required benefits:

• Maternity Minimum Stay
• Catastrophic coverage of mental health conditions
• Coverage for prosthetic devices
• Coverage of Diabetes
• Mastectomy coverage
• Dietary products for inborn metabolic errors
• Autism Spectrum Disorder

Certain limitations and exclusions apply and may include the following examples:

• Ankle-foot orthotics
• Automated home blood pressure monitoring equipment
• Batteries (for any purpose)
• BiPAP and CPAP machines (including eligible attachments and supplies)
• Blood storage – autologous for future use
• Cane or quad cane
• Cardiac rehab; phases 3 and 4
• Chest compression vest, system generator, and hoses
• Circumcision
• Computer-assisted interpretation of x-rays (except mammograms)
• Computer-assisted navigation for orthopedic procedures
• Crutches
• Dynasplint
• Electrodes and accessories for stimulators
• Enuresis alarm unit
• Face Masks
• Fracture frame
• Freestanding/home cervical traction
• Glucometer (blood glucose monitor)
• Home anticoagulation or hemoglobin A1C testing
• Hospital beds and related parts or equipment
• Humidifiers
• Interferential/neuromuscular stimulators
• Lymphedema pump (pneumatic compressor), sleeves and supplies
• Magnetic Source Imaging (MSI)
• Manipulation under anesthesia
• Mastectomy bra
• Micro phlebectomy (stab phlebectomy)
• Pediatric/Infant scales
• Percussor, chest
• Postural drainage board
• Private Duty Nursing (PDN)
• Prosthesis, limb and supplies
• Protonic knee orthosis
• Radiofrequency ablation for lateral epicondylitis
• Scooter boards
• Sleep studies
• Speech generating device
• Stander
• Stereotactic radiosurgery
• Support hose (elastic stockings, surgical stockings)
• Tracheostomy speaking valve
• TENS unit
• Walkers and attachments
• Wheelchair -certain parts and accessories

What's the difference between Standard Utah Plans and Benchmark Plans?

Standard Utah Plans vs. Benchmark Plans

Utah offers three plan variations that satisfy the EHB mandate. Standard and Benchmark plans only cover EHBs, while Non-Benchmark plans cover EHBs as well as additional services. Standard and Benchmark plans may be a lower cost alternative to traditional Individual & Family (Affordable Care Act) plans. They only cover Essential Health Benefits as defined by your state.