Idaho 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, Idaho has the following state-required benefits:
- Maternity minimum stay
- Mammography coverage
- Breast reconstruction, if mastectomy is covered
- Congenital anomaly (e.g., cleft lip and palate)
Certain limitations and exclusions apply.