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State Insurance Mandates and the ACA Essential Benefits Provisions
Source: NCSL

Every state has a substantial number of laws that require private market health insurance to cover specific benefits and provider services. An introduction to such laws is provided below, titled Understanding Mandated Health Insurance Benefits.

State Mandated Benefits

Traditionally states counted health mandate laws to include required categories of up to 70 distinct “benefits” as well as “health providers” (such as acupuncturists or chiropractors) and “persons covered” (such as adopted children, handicapped dependents or adult dependents). Adding up these laws, there are more than 1,900 such statutes among all 50 states; another analysis tallies more than 2,200 individual statute provisions, adopted over a 30+ year period.

Federal “Essential Health Benefits (EHB)

The Patient Protection and Affordable Care Act (ACA) provides for “essential health benefits,” defined as health treatment and services benefits in sections 1302(a) and (b). These combined benefit requirements apply to all policies sold in Exchanges and in the small group and individual markets, effective October 1, 2013. The benefits are covered for individual patient treatments beginning January 1, 2014 and continuing at least through policy plan years 2017 and 2018. 1,2

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