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.

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:

Examples of Essential Benefits in a sentence

• In the event that cover in respect of any benefit set out in the Silver or Gold 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.

• In accordance with the laws of Dubai and the various circulars and guidelines issued by the DHA, the Primary Benefits plan is the insurer's equivalent to the DHA Essential Benefits plan, which sets out the minimum benefits required for private health insurance plans in the Emirate of Dubai.

• Essential Benefits include those services set forth in regulations issued by the Department of Health and Human Services pursuant to the Patient Protection and Affordable Care Act (PPACA).

• If cover in respect of any benefit of the Flex plan is lower than the benefit provided under the DHA Essential Benefits plan, the cover provided under the DHA Essential Benefits plan shall apply.

• This authority will remain in force until specifically revoked in writing and delivered to us.

• The Department has not finalized its internal review to determine adjustments that may need to be made to the Department’s Covered Benefits to ensure compliance with the Essential Benefits requirement of the Affordable Care Act (“ACA”).

• The Department has finalized its internal review to determine adjustments that need to be made to the Department’s Covered Benefits to ensure compliance with the Essential Benefits requirement of the Affordable Care Act.

• Unless specifically stated in the table of benefits for your plan type, or specifically covered under the Dubai Health Authority Essential Benefits • Dependency on or abuse of alcohol, drugs or other addictive substances; or • Any illness or injury arising directly or indirectly from such dependency or abuse.

• A description of cover provided by the Dubai Health Authority Essential Benefits plan Is set out on page 6 of this agreement.

• The limits shown in the DHA Essential Benefits Plan table of benefits are the maximum amounts we will pay after the application of any excess and Benefit Benefit LimPitLAN The overall maximum limit to the amount that you can claim during any one period of cover.

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.