Guaranteed Essential Benefits
Under the Affordable Care Act (ACA), all health plans in California must cover 10 categories of essential health benefits.
- Ambulatory services: outpatient doctor visits
- Emergency services: ER and ambulance
- Hospitalization: surgeries, overnight stays
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitation services
- Laboratory services
- Preventive and wellness services
- Pediatric services including dental and vision
What Is NOT Typically Covered?
Cosmetic procedures, adult dental (unless added as a rider), adult vision, and experimental treatments are generally not covered under standard plans.
Key Terms You Should Know
Premium: what you pay monthly. Deductible: what you pay before insurance kicks in. Copay: a fixed amount per visit. Coinsurance: the percentage you pay after the deductible.
