All health plans purchased through NY State of Health, the health insurance marketplace for New York, must include the following benefits whether or not you have a pre-existing health condition.
These are known under the Affordable Care Act as “essential health benefits”:
- Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
- Emergency services
- Hospitalization (including surgery)
- Maternity and newborn care
- Mental health and substance use disorder services (including counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services (including oral and vision care)
Companies that offer plans through NY State of Health will compete on price and quality of service in delivering these benefits.