Essential Health Benefits

With health care reform, fully insured small group, individual health plans and large group and exchange plans must cover essential health benefits beginning January 1, 2014. The U.S. Department of Health and Human Services will decide what benefits will be included by the deadline.

Essential health benefits under the Patient Protection and Affordable Care Act will include the following general categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services (including behavioral health treatment)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Reform says that plans must cover these benefits with no annual limits or lifetime maximums.

As Department of Health and Human Services defines essential health benefits, we will keep you updated with news alerts, webinars and other tools.

For more information about Cigna’s position and advocacy on essential health benefits, please read our Essential Health Benefits white paper.

What's Your Role in Reform?

We've prepared information about health care reform just for you.

Employers and organizationsBrokers and consultantsHealth care professionalsIndividuals and families

Tools for Managing Reform

Our health care reform tools make it easy for you to manage and track health insurance reform.

Health care reform overviewHealth care reform timelineState insurance exchange mapRead Reform Today

Key Health Care Reform Rules

Health insurance reform changes how we all operate.

State insurance exchangesEmployer insurance rulesIndividual mandate in reform

Questions about Reform?

Read answers to frequently asked questions about health care reform.