Individual and Family Plan Provided Health Care Services

Qualified health plans sold in the Public Marketplace and every health plan offered in the Private Marketplace must offer the following 10 essential health benefits regardless of the plan’s metal level. As long as you’re in network, the benefits apply.

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)

  • Emergency services

  • Hospitalization, such as surgery and overnight stays

  • Pregnancy, maternity, and newborn care before and after birth

  • Mental health and substance use disorder services, including behavioral health treatment (counseling, psychotherapy, etc.)

  • Prescription drugs

  • Rehabilitative and habilitative services and devices to assist people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills

  • Laboratory services

  • Preventive, wellness services, and chronic disease management

  • Pediatric services, including dental and vision care for children

There are no annual or lifetime limits on these plans.

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Individual and Family Plan Covered Services Reminders

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Individual and Family Plan Coverage Levels