Individual and Family Plan Coverage
Minimum Essential Coverage
All qualified health plans must offer the following 10 essential health benefits regardless of the plan’s metal level. The benefits apply as long as you’re in-network.
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 to regain or improve 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.
Detailed Coverage
Each health plan includes a Summary of Benefits and Coverage (SBC) that outlines the services and benefits covered by the plan, any limitations or exclusions, and the associated costs. You can review a plan's SBC before enrolling or request another copy after enrollment. See Covered Services to learn how.