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Essential Health Benefits

Coverage for A Range of Core Services

The ACA requires that health plans offered in the Individual and Small Business Marketplace, both inside and outside of the Marketplaces, provide coverage for a range of “core” services known as essential health benefits (EHB). CDPHP already covers many of these services.

Plans must include coverage within the following 10 categories:

  • Ambulatory and emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription drugs*
  • Mental health and substance abuse service
  • Rehabilitative and habilitative care
  • Laboratory service
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services, including oral and vision care

*Prescription drug coverage: All plans must include prescription drug coverage whether it is purchased on or off the Marketplace. This means the benefit is included with the base medical coverage and is not a separate rider.

Pediatric dental coverage is required for small group health plans under the ACA. When your employees enroll in a Delta Dental plan through CDPHP, they will obtain the essential pediatric coverage they need. 

Save Money, Stay Healthy
Employees receive significant discounts on prescription drugs through our Rx for Less program. And, don’t forget that CDPHP covers a variety of preventive care services to help your employees stay healthy.

Please note that EHBs apply to non-grandfathered plans. A “grandfathered” plan is a group health plan that was created on or before March 23, 2010, when the ACA became law. This also applies to an individual health insurance policy that was purchased on or before March 23, 2010.