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Essential Health Benefits: Get More for Your Money

Upgrading to the Meal

That glorious moment when the server at a restaurant clarifies that your meal comes with a drink … not for an extra cost, but with. Wow, what a moment. As of January 1, 2014, your health insurance plan comes with Essential Health Benefits.

If you’ve been a Health Alliance member before, we’ve covered many of these benefits for years, so you won’t see or feel much change. But if you’re new to us, welcome and enjoy!

Essential Health Benefits stretch across 10 categories. By law, no matter your age, gender, or medical history, you’re covered in these 10 areas.

Essential Health Benefits

Details

Ambulatory Patient Services Care you get at a doctor’s office, clinic, or outpatient surgery center, including home health services and hospice care.
Emergency Services Care provided in an emergency situation where you believe your health is in serious danger, like chest pain, a broken bone, or unconsciousness.
Hospitalization Care from doctors, nurses, and hospital staff, room and board, surgeries, and transplants you receive during your hospital stay, or care in a skilled nursing facility.
Laboratory Services Testing to help a doctor diagnose an injury, illness, or condition, or monitor how well a treatment is working.
Maternity and Newborn Care Prenatal care through newborn care.
Mental Health Services and Addiction Treatment Inpatient and outpatient care to treat a mental health condition or substance abuse.
Rehab Services and Devices Services and devices to help you regain mental and physical skills lost because of injury, disability, or a chronic condition.
Pediatric Services Wellness visits and recommended vaccines and immunizations for infants and children, as well as dental and vision care for children under 19 years old.
Prescription Drugs Antibiotics and medicines to treat an ongoing condition, like high cholesterol.
Preventive and Wellness Services and Chronic Disease Treatment Physicals, immunizations, preventive screenings, and care for chronic conditions, like asthma and diabetes.

*Some services do have limits.