What is essential health benefits in GCI?

Essential health benefits in Get Covered Illinois (GCI) encompass a set of health care service categories that must be included in health plans offered in the marketplace. These benefits are critical to ensuring that individuals and families have access to a comprehensive range of health services necessary for maintaining health and managing illnesses. They include, but are not limited to, preventive services, maternity care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, and pediatric services.

The emphasis on critical health services like preventive care and maternity care ensures that health plans cover essential treatments that can significantly impact an individual’s health outcomes and overall well-being. For instance, preventive services help catch potential health issues early on, reducing the need for more extensive and costly treatments later. Maternity care supports women during pregnancy, childbirth, and postpartum processes, integral to both maternal and child health.

The other options do not meet the criteria for essential health benefits as defined by GCI. Cosmetic procedures and elective surgeries are typically not covered under essential benefits as they are often not deemed necessary for health maintenance. Similarly, while emergency health services are important, they are just one aspect of the broader essential benefits category, which includes various other health services. General health education services also fall outside