Utah Essential Health Benefits
States are allowed flexibility when selecting their EHB-benchmark plan. This page will detail your state’s specific selections.
States are allowed flexibility when selecting their EHB-benchmark plan. This page will detail your state’s specific selections.
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:
Certain limitations and exclusions apply and may include the following examples:
The Affordable Care Act (ACA) mandates that any Individual plan, both on and off the Marketplace, that took effect after 2013 must cover certain Essential Health Benefits (EHBs) for new and renewing members. To satisfy this mandate, we offer Benchmark and Standardized plans that only cover EHBs. Our Non-Benchmark plans cover EHBs alongside additional services.