What are Essential Health Benefits?

These benefits include the types of care you need to prevent and treat sickness. They do not include elective and “non-essential treatments.” 

Essential Health Benefits are minimum requirements for all individual health insurance plans. They cannot be subject to an annual or lifetime dollar limit. 
 
Certain Essential Health Benefits, such as specific preventive services and annual wellness visits, are fully covered without out-of-pocket costs like copays or coinsurance. Once you meet your out-of-pocket maximum, all plans pay 100% for covered in-network Essential Health Benefits beyond the specific preventive services noted above.

Every health plan offered through Hixme must cover the following services:
 
Preventive, wellness, and disease management services Yearly physical, flu shot, gynecological exam, birth control
Emergency care Treatment for broken bones, heart attacks, and more at a hospital emergency room
Ambulatory services Minor surgeries, blood tests, X-rays
Hospitalization Treatment at a hospital for a condition that requires you to stay overnight or multiple days
Maternity and newborn services Care through the course of a pregnancy, delivery of the baby, and checkups after the baby is born
Pediatric services, including dental and vision Well visits, shots to prevent serious health conditions, teeth cleanings and exams, frames, lenses
Prescription drugs High blood pressure medicine, insulin, antibiotics, birth control pills
Laboratory services Blood tests
Mental health and substance abuse services, including behavioral health treatment Getting help to deal with conditions like depression, alcohol abuse, and drug abuse
Rehabilitation and habilitation services Physical therapy, speech therapy, occupational therapy
 
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