Great news … hip, hip, hooray! Not stoked yet? Don’t know why you should be? There are many new healthcare guidelines in the Affordable Care Act, but one you are sure to want to know about is this: all new health insurance plans, effective on or after Jan. 1, 2014, in the individual and small group markets (that’s businesses with fewer than 50 employees), must cover a comprehensive package of items and services known as the essential health benefits. The essential health benefits are the minimum requirements plans for individuals, families and small businesses should have; many plans will offer additional coverage. Bonus: there are no annual or lifetime dollar limits for essential health benefits services.

So, let’s get right to explaining each of these healthcare service categories, and as you read through this list, think about when and how often you have used these services in the past. Better yet, how often you’ve wanted to, but couldn’t, because you didn’t have insurance.

The essential health benefits include at least the following:

  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care (care before and after a baby is born)
  5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including vision

One of the most exciting components is No. 9: preventive and wellness services for adults and children. Yes, exciting, for more reasons than you may know! First, because preventive care helps you and your loved ones get and/or stay healthy, and are services you can use right away. Gone is the old thinking that a healthcare professional, like a doctor or nurse practitioner, is someone to see only when you’re sick. Second, all, of the preventive services must be free of charge, at no out-of-pocket cost for you if they are delivered by a network provider (one important reason you should remember to choose a plan that includes the doctors and hospitals you frequent). No out-of-pocket cost means you don’t pay a copayment or coinsurance, and you don’t have to have met your yearly deductible (read last month’s article if you want to know what these mean).

Preventive services are based on your age, gender and health status, including annual check-ups; health screenings (e.g., blood pressure cholesterol, depression, diabetes); and immunizations (e.g., diptheria, pertussis and tetanus (DPT), flu, hepatitis A and B, and measles, mumps and rubella (MMR)). Screenings specifically for women (e.g., anemia, mammography, cervical cancer) and children (e.g., autism, hearing, lead poisoning) also are covered free of charge.

The message is clear: there are many benefits for you that come at no cost.

For more information on CoOportunity Health — Iowa and Nebraska’s new, nonprofit health insurance CO-OP, go to or call 1-866-217-6111, Monday-Friday, 8 AM-6 PM.