Essential Benefits definition

Essential Benefits include the following: ambulatory services; Emergency Services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services (including behavioral health treatment); 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. Such benefits shall be consistent with those set forth under the Patient Protection and Affordable Care Act of 2010 and any regulations issued pursuant thereto.
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Essential Benefits means: 1) Ambulatory patient services; 2) Emergency services; 3) Hospitalization; 4) Maternity and newborn care; 5) Mental health and substance abuse, including behavioral health treatment; 6) Prescription drugs; 7) Rehabilitative and habilitative services and devices; 8) Laboratory services; 9) Preventive and wellness services and chronic disease management; and 10) Pediatric services, including oral and vision care. There are no annual or lifetime dollar limits applicable to essential benefits. Any benefit-specific dollar limits referenced in the Schedule of Benefits pertain only to those health care services and supplies that are not essential benefits.
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Essential Benefits means the following categories of items and services, as those items and services are defined by federal regulation pursuant to Section 1302(b) of the federal Patient Protection and Affordable Care Act:
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Examples of Essential Benefits in a sentence

  • Subtitle C—Standards Guaranteeing Access to Essential Benefits Sec.

  • Essential Benefits do not have an annual maximum accumulated payment threshold.Adverse Determination: A determination by EmblemHealth or its agents that an admission, extension of stay, or other health care service has been reviewed and, based on the information provided, is not medically necessary, or is experimental or investigational in nature, and therefore not covered.Balance-of-Charges: Non-Network Providers have not agreed to accept EmblemHealth’s Allowed Charge as payment in full.

  • All other provisions remain as described in your Subscriber Certificate.attached to and made part ofBlue Cross and Blue Shield of Massachusetts, Inc.Dental Blue Policy BCBS-DENT (1-1-2014) Schedule of Dental BenefitsPediatric Essential Benefits This is the Schedule of Dental Benefits that is a part of your Dental Blue Policy.

  • See “State Insurance Mandates and the ACA Essential Benefits Provisions,” National Conference of State Legislators (Oct.2017).

  • This document was produced for review by the United States Agency for International Development Philippine Mission (USAID/ Philippines).PROJECT PROFILE Program:USAID/PHILIPPINESMARAWI RESPONSE PROJECT (MRP)Activity Start Date and End Date:August 29, 2018 – August 28, 2021Name of Prime Implementing Partner:Plan USA International Inc.Cooperative Agreement Number:72049218CA00007Names of Subcontractors/Sub awardees:Ecosystems Work for Essential Benefits (ECOWEB) and Maranao People Development Center, Inc.

  • There are no annual or lifetime maximum payment thresholds on Essential Benefits.

  • Except for Essential Benefits, a qualified HDHP may not provide benefits until the deductible has been met.

  • Figure 1: Estimated Premium Changes and Percent of Members Impacted Premium Impact Essential Benefits The ACA requires that all benefit plans cover services for essential health benefits, some of which are often excluded in the current individual market.

  • In the event that cover in respect of any benefit set out in the Foundation or Foundation Plus Global Health plan is lower than the benefit provided under the Dubai Health Authority Essential Benefits plan, the cover provided under the Dubai Health Authority Essential Benefits plan shall apply.

  • Establishing Essential Benefits and enhancing preventive services Comment [MK1]: Need to update prior to submission – will have resolution by 5/8Division staff worked with the Colorado Consumer Health Initiative, Colorado Association of Health Plans, the Colorado Competitive Council (business group), health care providers and many other stakeholders through a collaborative process including gathering input through dozens of public meetings, phone calls, and e-mails.


More Definitions of Essential Benefits

Essential Benefits means: 1) Ambulatory patient services; 2) Emergency services;3) Hospitalization; 4) Maternity and newborn care; 5) Mental health and substance abuse, including behavioral health treatment; 6) Prescription drugs; 7) Rehabilitative services;8) Laboratory services; 9) Preventive and wellness services and chronic disease management; 10) Pediatric services, including oral and vision care. If benefits defined as “essential” are already covered as part of this grandfathered plan, they must be covered without dollar limits in-network and out-of-network. Any other benefit-specific dollar limits referenced in the Plan pertain only to those health care services and supplies thatare not essential benefits. Note: The maximums listed below are the total for Network and Non-Network expenses. For example, if a maximum of 60 days is listed twice under a service, the Calendar Year maximumis 60 days total, which may be split between Network and Non-Network providers. DEDUCTIBLE, PER CALENDAR YEAR: All applicable In-Network monies paid by the Plan Participant toward the deductible will be combined with Non-Network monies paid for the purpose of determining whether the Non-Network deductible has been met.
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Related to Essential Benefits

  • Essential Health Benefits means, under section 1302(b) of the Patient Protection and Affordable Care Act, those health benefits to include at least the following general categories and the items and services covered within the categories: ambulatory patient services; Emergency Services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; 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.

  • Severance Benefits mean the payment of severance compensation as provided in Section 2.3 herein.

  • material benefit means a benefit which may not be financial but has a monetary value;

  • Special benefit means, for purposes of a property-based district, a particular and distinct benefit over and above general benefits conferred on real property located in a district or to the public at large. Special benefit includes incidental or collateral effects that arise from the improvements, maintenance, or activities of property-based districts even if those incidental or collateral effects benefit property or persons not assessed. Special benefit excludes general enhancement of property value.

  • Employment Termination means the effective date of: (i) Executive’s voluntary termination of employment with the Company with Good Reason, or (ii) the termination of Executive’s employment by the Company without Good Cause.