What are essential health benefits provided under GCI?

The essential health benefits under Get Covered Illinois (GCI) refer to a set of health care service categories that must be covered by all qualified health plans. This ensures that individuals who obtain insurance through the marketplace receive comprehensive care across a range of necessary services.

These essential health benefits are critical as they establish a baseline for care and ensure that individuals have access to a minimum standard of coverage, which includes services such as emergency care, maternity and newborn care, mental health services, prescription drugs, preventive and wellness services, and more. By mandating these benefits, GCI aims to enhance access to necessary medical services and improve overall public health outcomes.

In contrast, other options like special coverage for the elderly or optional benefits based on individual needs do not represent the core principle of essential health benefits, which focuses on a standardized coverage requirement for all insured individuals. Similarly, limiting coverage to solely physical health neglects the broader scope of services intended to address comprehensive health care, including mental and behavioral health services.