ACA-compliant individual and small-group plans generally cover categories of essential health benefits. The categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care as applicable to the rules.
Why plan documents still matter
The required benefit categories do not mean every specific service, provider, or medication is covered in the same way. Plans can have cost-sharing, network rules, service limits, and medical management requirements subject to applicable law. Pediatric dental and other benefit arrangements can differ under the governing rules.
Verify the plan
Review the plan's Summary of Benefits and Coverage and detailed policy for the services you expect to use. Ask the insurer about coverage rules for a particular service and confirm participating providers. For official background, see HealthCare.gov: what plans cover.