Federal Employees Health Benefits Program (FEHBP) Medicare Medicaid Knox-Keene Health Care Service Plan Act (CA) Maryland Massachusetts Exchange
Year Created 1959 1965 1965 1975 1993 2006
Categorization of Benefits Service Benefit Plan Part A Mandatory Services Basic Health Care Services Comprehensive Standard Health Benefit Plan (CSHBP) Minimum Creditable Coverage Standards
  • Hospital benefits
  • Surgical benefits
  • In-hospital medical benefits
  • Ambulatory patient benefits
  • Supplemental benefits
  • Obstetrical benefits
  • Inpatient hospital
  • Skilled nursing facility
  • Home health
  • Hospice
  • Inpatient psychiatric hospital
  • Physician services
  • Lab and X-ray services
  • Inpatient hospital services
  • Outpatient hospital services
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for children under 21
  • Family planning services
  • Federally qualified health center services
  • Rural health clinic services
  • Nurse midwife services
  • Certified nurse practitioner services
  • Nursing facility services for those ages 21 and over
  • Home health care services
  • Hospital inpatient services
  • Physician services
  • Outpatient and ambulatory care
  • Lab and radiology
  • Home health
  • Preventive health services
  • Emergency services (including ambulance and out-of-area coverage)
  • Hospice (section 1368.2-only for group coverage)
  • Ambulance service
  • Audiology screening for newborns
  • Blood and blood products
  • Case management program
  • Chiropractic services
  • Durable medical equipment
  • Emergency room
  • Family planning services
  • Habilitative services
  • Hearing aids
  • Home health care
  • Hospice
  • Hospitalization, includes detoxification
  • Infertility services
  • Medical food
  • Mental health and substance abuse
  • Nutritional services
  • Outpatient hospital services and surgery
  • Outpatient laboratory and diagnostic services
  • Outpatient short-term rehabilitative services
  • Pregnancy and maternity
  • Prescription drugs
  • Ambulatory patient services (including outpatient day surgery and related anesthesia)
  • Diagnostic imaging and screening procedures (including x-rays)
  • Emergency services
  • Hospitalization (including at a minimum, inpatient acute care services, which are generally provided by an acute care hospital for covered benefits in accordance with the member’s subscriber certificate or plan description)
  • Maternity and newborn care
  • Medical or surgical care (including preventative and primary care)
  • Mental health and substance abuse services
  • Prescription drugs
  • Radiation therapy and chemotherapy
  • Doctor visits for preventive care, without a deductible


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