Which of the following is not among the essential health benefit categories that a non-grandfathered individual health plan must cover under the Affordable Care Act?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
ACA Section 1302 sets out the essential health benefit categories, which include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care for children. Adult dental and routine adult vision care are not required categories, although pediatric oral and vision care is. A Texas agent should therefore not tell an adult applicant that dental and vision must be included.
Why the other options are wrong
- A) Maternity and newborn care is a required essential health benefit category.
- B) Emergency services is a required essential health benefit category.
- C) Prescription drugs is one of the required essential health benefit categories under ACA Section 1302.
Memory hook
Pediatric dental and vision yes; adult dental and vision no.