Essential Health Benefits


Beginning in 2014, the Affordable Care Act requires non-grand fathered health plans to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services;(3) hospitalization; (4) maternity and newborn care;(5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices;(8) laboratory services;(9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

The federal government defines the EHB based on state-specific EHB-benchmark plans. 

To view Wisconsin’s EHB benchmark plan:










WHA Contact:

Joanne Alig

Senior Vice President

Policy and Research