Section XXVII of the Public Health Service Act mandates that group health plans and health insurance issuers must cover certain benefits known as “essential health benefits” (EHBs). These benefits are designed to ensure that individuals and families have access to critical healthcare services in case of illness or injury.
Essential health benefits include a wide range of medical services, such as ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services.
The intent behind Section XXVII of the Public Health Service Act is to protect consumers from inadequate health insurance coverage and to promote access to essential health benefits. The law requires that all plans sold in the individual and small group markets, both inside and outside the Health Insurance Marketplace, cover the EHBs.
In addition to the EHBs, group health plans and insurers must also cover other preventive services, including certain immunizations, screenings, and preventive care services for women, without cost-sharing.
Under Section XXVII of the Public Health Service Act, health insurers cannot discriminate against individuals with pre-existing conditions, nor can they charge higher premiums based on a person’s health status or gender. This provision ensures fair and equal access to health insurance coverage for everyone, regardless of their health status or medical history.
In conclusion, Section XXVII of the Public Health Service Act is a critical provision that supports the provision of essential health benefits to all Americans. It ensures that group health plans and insurers cover a comprehensive array of medical services, including preventive and wellness services, mental health and substance use disorder services, and pediatric services. By requiring insurers to cover these essential benefits and preventing discrimination against individuals based on their health status, Section XXVII helps to ensure that all Americans have access to quality healthcare.
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