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CA Department of Insurance

Emergency Regulation Requires Health Insurers to Provide Coverage for Essential Health Benefits

News: 2013 Press Release

For Release: June 17, 2013
Media Calls Only: 916-492-3566
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Emergency regulation requires health insurers to provide coverage for essential health benefits

SACRAMENTO - Insurance Commissioner Dave Jones today announced the approval of an emergency regulation filed by the Department of Insurance with the Office of Administrative Law requiring health insurers to cover all essential health benefits for new policies in effect after January 1, 2014. The Affordable Care Act requires non-grandfathered health insurance policies offered in the individual and small group markets (both inside and outside of the Health Benefits Exchange) provide coverage for a comprehensive package of healthcare benefits, known as essential health benefits. The emergency regulation is a critical element of Affordable Care Act implementation.

"Our essential health benefits emergency regulation ensures all Californians purchasing individual or small group health insurance policies will have coverage for a comprehensive set of health benefits when they need medical care," said Commissioner Jones. "In the past, some policies have included very limited or no coverage for important healthcare services. Starting in January all the new health insurance policies will cover 10 broad categories of essential benefits that will meet most healthcare needs. Issuance of the emergency regulation is a critical step in the implementation of the Affordable Care Act, because it provides the legal authority for the department to implement the essential health benefits requirement as we review new health insurance policies sold, including those in the Exchange."

10 categories of benefits that make up the essential health benefits coverage, including:

  • Ambulatory patient services
  • Emergency services
  • Maternity and newborn care
  • Prescription drugs
  • Hospitalization
  • Laboratory services
  • Pediatric services, including oral and vision care
  • Rehabilitative and habilitative services and devices
  • Preventive and wellness services and chronic disease management
  • Mental health and substance use disorder services, including behavioral health treatment.

The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at Non-media inquiries should be directed to the Consumer Hotline at 800.927.4357. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.

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