ACA (Health Coverage under 65)

To be a compliant ACA plan, all of the following benefits must be provided:

1. Ambulatory (Outpatient) Services
   Doctor visits, clinics, outpatient surgery, and treatment that does not require hospital admission. 
2. Emergency Services
   ER visits and emergency care without needing prior authorization. 
3. Hospitalization
   Inpatient hospital stays, surgeries, overnight care, and related services. 
4. Maternity & Newborn Care
   Prenatal visits, labor and delivery, postpartum care, and newborn coverage. 
5. Mental Health & Substance Use Disorder Services
   Counseling, psychotherapy, psychiatric care, and addiction treatment. 
6. Prescription Drugs
   Coverage for medications, including at least one drug in every major category. 
7. Rehabilitative & Habilitative Services and Devices
   Physical therapy, occupational therapy, speech therapy, and devices that help regain or develop skills. 
8. Laboratory Services
   Blood work, diagnostic testing, screenings, and lab evaluations. 
9. Preventive & Wellness Services and Chronic Disease Management
   Many preventive services are covered at $0 cost when using in-network providers, including: 
   • Annual wellness visits 
   • Vaccines 
   • Mammograms 
   • Colonoscopies 
   • Blood pressure and diabetes screenings

and Number 10:

• Pediatric Services
  Includes care for children, dental coverage, and vision benefits for pediatric patients.