News & Updates

Defining "Essential Benefits"
In assessing which benefits we consider to be "essential benefits," in the absence of regulatory guidance, we considered several factors, including whether specific benefits are mandated by federal law, Massachusetts state law, and/or are required elements of Massachusetts minimum creditable coverage. Our initial determinations may evolve as federal regulatory guidance is issued.

The new national health care reform law defines essential health benefits to include at least the following general categories:

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 exams

This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.

Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.

For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.