Mandatory Inclusions in Affordable Health Care Plans
Except for grandfathered-plans (those that already existed in March 23, 2010) or employer-sponsored plans, the following provisions are mandatory inclusions in all individual health care coverage:
• Ambulatory patient services;
• Emergency services;
• Hospitalization, maternity and newborn care;
• Rehabilitation and habilitation services, including treatments for behavioral disorders, for sufferers of mental health disorders or users of prohibited substances. This includes prescription drugs and devices necessary for the patients’ way to wellness and recovery.
• Preventive and wellness services;
• Laboratory services,
• Pediatric services including oral and vision care;
• Management of chronic diseases;
• The law, as represented by the Secretary of Health and Human Services, reserves the right to add essential benefits for the rehabilitation and habilitation services considered essential to persons with disabilities and to other diverse and underserved groups.. Examples of these services are: maintenance of muscle bulk and minimization of spasticity.
• Medical devices refer to durable medical equipment like wheelchairs, prosthetics, orthotics and its supplies.
• The amount of out-of-pocket expenses shared by policy holder should not be greater than the limits of an individuals’ health savings account.
For more information about the new laws governing affordable health care coverage for everyone, including guidelines for employers who wish to provide health care plans to their employees, details are available at the US Dept. of Health and Human Services' – Regulations and Guidance page.