According to the Healthcare.gov website, essential health benefits (EHBs) are the “set of 10 categories of services that health insurance plans must cover under the Affordable Care Act. These include doctors’ service, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services and more.” With the coronavirus curve rising and falling all over the world, people have been confused as to how Covid-19 would relate to their EHBs. This article is meant to shed light on how your essential health benefits will cover you during this pandemic, with information from the Centers of Medicare & Medicaid Services (CMS).
Basically, essential health benefits are the categories of coverage that insurance plans MUST include. As an employer, you do have the liberty to modify the specifics and terms of the plan. Urge your employees to get in touch with your HR department to learn about what their insurance policy is able to cover.
Here’s a few things to note when discussing EHBs with your team.
1. EHBs include coverage for the diagnosis and treatment of COVID-19.
However, the coverage details and specifics will vary from plan to plan, with some plans requiring prior authorization before an employee receives health care.
2. Isolation and quarantine FOR diagnosis of COVID-19 are covered as EHBs.
Note, this means medically necessary isolation and quarantine (including medical care and benefits such as telemedicine) required by and under supervision of a medical provider. Self-quarantining and isolation outside of the hospital setting and without a medical provider is not a medical benefit nor is it an EHB.
3. The new COVID-19 vaccine, when available, need not be covered as an EHB until the beginning of the new plan year.
While specific vaccines are required by law to be covered as EHBs without cost-sharing and deductible requirements, plans do not need to cover a new vaccine until 12 months after the Advisory Committee on Immunization Practices (ACIP) approves it.
For more resources on health insurance coverage for your staff, visit NY Small Health and talk to their trusted insurance experts.