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Certified Public Accountant, New Jersey
Manny Forlenza CPA

Minimum Essential Coverage

The ACA seeks to improve the overall quality of health care insurance, in a couple of different ways. First, it required that all health plans offer the following essential benefits, which are already in effect:
  • An individual cannot be turned down for insurance due to a pre-existing condition.
  • Premiums cannot vary by gender - they can only vary by the state the individual is insured in, the age of the insured, and in some cases, whether the insured is a smoker.
  • Employer plans that cover dependents must offer coverage for employees' adult children up to age 26, even if the child is no longer a dependent.

Second, the minimum essential coverage requirement requires a plan to provide the following 10 essential benefits in order to be sold on a Health Insurance Marketplace:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care.