AD Banker Comprehensive Practice Exam

Which of the following is considered not to be an Essential Health Benefit?

1. Mental health services

2. Behavioral health treatment

3. Personal care

4. Ambulatory patient services

The correct answer is: Personal care

Essential Health Benefits are a set of healthcare service categories that must be covered by certain health plans, particularly those offered in the individual and small group markets under the Affordable Care Act. The law outlines ten categories of services that qualify as Essential Health Benefits, which include mental health services, behavioral health treatment, and ambulatory patient services. Personal care, however, is not classified as an Essential Health Benefit. While it is an important aspect of healthcare, personal care services typically refer to assistance with daily living activities, such as bathing, dressing, and grooming, and are often covered under different types of policies like long-term care insurance or Medicaid, but not necessarily under the plans that mandate Essential Health Benefits. Thus, the answer correctly identifies personal care as not being categorized as an Essential Health Benefit within the framework established by the Affordable Care Act. This distinction is crucial for understanding what is mandated for insurance coverage versus what might be provided under other insurance arrangements or programs.