Posted by: Dal Watson | September 22, 2010

“Essential Health Benefits” Defined Under New Health Care Reform Law:

‘Grandfathered’ Group Health Plans may not establish lifetime or annual dollar limits on the benefits for any participant or beneficiary. However, (1) “restricted annual limits” (to be defined) on “essential health benefits” are permitted until January 1, 2014, and (2) per beneficiary lifetime and annual limits on specific covered benefits that are not “essential health benefits” are permitted without a time limit. Although “essential health benefits” is subject to further definition, it includes at least the following services:

ambulatory, emergency, mental health and substance use disorder, rehabilitative, laboratory, preventive, wellness, and pediatric services, hospitalization, maternity and newborn care, prescription drugs, and disease management.


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