10 Essential Health Insurance Benefits

10 Essential Health Insurance Benefits

November 11, 2020

10 Essential Health Insurance Benefits

When choosing a health insurance plan, your primary goal should be to find a policy covering your medical needs. While no insurance plan is going to hit the mark 100 percent of the time, it is possible to get the coverage that, at the very least, covers the basics. So, what are the basics? What type of plan should you look for that covers essential health insurance benefits?

Nearly every health insurance company in your state offers baseline coverage for things like ambulatory services, emergency care, hospitalization, prescriptions, lab work, or pediatric services. Beyond that, you may need to assess your personal needs and add or take away your coverage as needed. If you are unsure where to begin, feel free to contact an insurance broker at Insurance Enterprise. We are here to help you get the right coverage that you can afford.

What Are Essential Health Insurance Benefits

Standard health insurance benefits are typically broken down into categories, further broken down into detailed coverage for specific medical services. The ten essential health benefit categories include

  • Ambulatory patient services
  • Emergency services
  • Hospitalization (surgery, overnight stays)
  • Pregnancy, maternity, and newborn care (before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (counseling, psychotherapy)
  • Prescription drug coverage
  • Rehabilitative and habilitative services and devices (services and devices for injuries, disabilities, or chronic conditions)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (for children only)


Ambulatory Services

Ambulatory care refers to medical services performed on an outpatient basis, without admission to a hospital or other facility (MedPAC). It is provided in settings such as offices of physicians and other healthcare professionals, as well as hospital outpatient departments.


Emergency Services

Emergency medical services, also known as ambulance services or paramedic services, are emergency services that provide urgent prehospital treatment and stabilization for serious illness and injuries and transport to definitive care.



Hospitalization is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive outpatient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma.


Pregnancy, Maternity

Prenatal care is provided in medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition, including prenatal vitamins, which prevents potential health problems.


Mental Health and Behavioral Treatment

Mental health services cover a broad range of mental health issues, behavioral disorders, and addictions. Treatment may include detoxification, rehab, counseling, therapy, and some aftercare services. Clients may have access to residential and outpatient services, depending on the nature and severity of their addiction.


Prescription Drug Coverage

Prescription drugs are generally more potent than those sold over the counter (OTC) and may have more serious side effects if inappropriately used. Therefore, these medications are only sold under a doctor’s direction. These directions are written in the prescription, then double-checked, packaged, and sold by a pharmacist. A pharmacist will counsel the patient on using the medication and the drug’s potential side effects.


Rehabilitative Devices

Rehabilitative devices are aids that help people recover their functioning after injury or illness. Assistive devices or equipment may be as simple as a magnifying glass to improve vision or as complex as a digital communication system. The goal of these devices is to improve the client’s performance and independence.


Laboratory Services

Labs enable physicians and other healthcare professionals to make appropriate evidence-based diagnostic or therapeutic decisions for their patients. Clinical laboratory services directly impact many aspects of patient care, including, but not limited to, length of stay, patient safety, resource utilization, and customer satisfaction.


Preventative and Wellness Services

Preventive healthcare consists of measures taken for disease prevention. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices and are dynamic processes that begin before individuals realize they are affected.


Pediatric Services

Pediatrics focuses on the health and medical care of infants, children, and adolescents from birth up to the age of 18. Physicians provide medical care for children who are acutely or chronically and preventive health services for healthy children.

Which Health Insurance Plan is Best for Me?

You may be wondering which health insurance company is the best? When choosing a plan, you first need to assess your personal healthcare needs, look at all your options, and choose a health insurance plan that fits in your budget. How do you determine which health insurance is best? Ask yourself these questions:

  • How often do you visit your doctor?
  • What type of treatment do you need in the next 12 months?
  • What prescription drugs do you currently take?
  • Which healthcare providers/physicians do you prefer?

Once you decide your healthcare needs, you can narrow your search to health insurance companies in your state. Some of the health insurance providers that we work with include:

  • 41881105-0
  • 41881105-0
  • 41881040
  • cigna-logo-vector
  • 41881020
  • 51482052-0-IAIC-Color
  • 41881045-0-kaiser
  • 41881070-0-Untitled-1-1
  • Philadelphia-America
  • 47121850

We Offer Affordable Health Insurance in These States:

Contact Insurance Enterprise for Premier Health Insurance

If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.