Essential Health Benefits Under the Affordable Care Act

The Affordable Care Act requires non-grandfathered health plans to cover certain essential health benefits. These benefits include ambulatory patient services, emergency room visits, hospitalization, behavioral health treatment, prescription drugs, rehabilitative and habilitative services, and preventative and wellness services. For example, the health insurance plan must cover preventative care, wellness, pediatric, and chronic disease management services. Other essential health benefits are not required by law.

Exceptions to the 10 categories of essential health benefits

The Affordable Care Act requires health insurance plans to cover at least ten categories of essential health benefits, including prescription drugs, preventive care, and doctors’ services. Preventive services are not subject to deductibles or out-of-pocket limits, and they include dental, vision, and pediatric care. Unless religious restrictions are in place, insurers must provide contraceptives. Other services must be free of charge, including breastfeeding counseling and breast pumps. Exceptions to the 10 categories of essential health benefits are not allowed for plans that are older than five years old.

The IOM report issued Oct. 6 calls for HHS to formalize the list by May 2012 so that all plans are required to cover essential health benefits. The report also urges states to conduct a public deliberative process. It’s unclear whether or not the recommendations will be implemented, but the new policy could make implementation easier. In the meantime, states are free to modify and replace some of the essential benefits in their plans as they see fit.

Preexisting condition exclusionary period

A preexisting condition exclusionary period for health insurance limits a policyholder’s health benefits for a certain period of time. This is based on whether the health problem occurred before the insurance application date. While most states have banned preexisting condition exclusionary periods, certain states still have them. These exclusionary periods can be waived if the policyholder has creditable medical coverage.

Under the ACA, health insurance plans cannot exclude a member’s pre-existing condition if he or she was diagnosed and treated within six months of the start of the coverage period. However, group health plans can apply this exclusionary period to conditions that occurred during the prior 12 months. For example, if a person’s preexisting condition is a pregnancy, he or she must have been uninsured for four months before he or she could enroll in a group plan.

Acute Onset of a Preexisting Condition is considered to be the first occurrence of the condition and is limited to one benefit per policy period. If the preexisting condition is repeated or reoccurring, it will not qualify for coverage. Exceptions include chronic or congenital conditions, drug use, or expected medical treatments. A policy may not have a Pre-existing condition exclusionary period if the coverage is based on the policyholder’s age.

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Genetic status is not an excludable condition

The Office of Civil Rights (OCR) has proposed amending the Privacy Rule to clarify that genetic information is health information. This rule would prohibit insurers from using genetic information for underwriting purposes, including eligibility determinations, premium computations, applications of pre-existing condition exclusions, and activities related to contract renewal or replacement. The proposed rule is now available for public comment. The agency’s proposed rule is subject to a 60-day comment period.

There are various restrictions on the use of genetic information in the workplace. While the ADA and GINA do not specifically prohibit genetic discrimination in the workplace, the latter does. The EEOC enforces Title II of GINA, which prohibits genetic discrimination in employment. The Departments of Labor, Health and Human Services, and Treasury also issue regulations related to the use of genetic information in health insurance.

Effects of vigorous activity on health

Researchers have long suspected that moderate to vigorous activity has a protective effect on cardiovascular health and mortality. However, recent studies show that the association between vigorous physical activity and a decreased risk of all-cause mortality is weak. This study investigated the effect of vigorous MVPA on mortality in both men and women. Researchers found that participants with an average of 30 minutes of MVPA each week had a 15% lower risk of all-cause mortality than those with low amounts of vigorous activity.

Vigorous physical activity has many benefits and should be included as a regular part of your lifestyle. The most obvious benefit is increased energy. In addition to improving your body’s metabolic health, vigorous exercise improves mental performance, as it stimulates neural activity and improves memory. Studies have shown that vigorous physical activity helps improve grades and cognitive performance in older populations. For more information on the benefits of vigorous physical activity, check out the links below. Visit here at to read latest health articles.

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