What do Qualified Health Plans need to guarantee according to ACA regulations?

Qualified Health Plans (QHPs) are required to provide essential health benefits as stipulated by the Affordable Care Act (ACA). This mandates that all insurance policies sold in the individual and small group markets cover a core set of services, including but not limited to, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation services and devices, laboratory services, preventive and wellness services, and pediatric services.

Additionally, the ACA prohibits these plans from including pre-existing condition exclusions, meaning that individuals cannot be denied coverage or charged higher premiums based on a health condition that existed before the start of coverage. This provision is crucial for promoting access to healthcare for all individuals, ensuring that health insurance is meaningful and effective regardless of one’s health status prior to obtaining coverage.

In contrast, the other choices do not align with ACA regulations, as selective coverage for high-risk individuals would undermine equitable access to care, lifetime limits on coverage would restrict benefits and contradict the ACA's focus on comprehensive coverage, and high premiums for senior citizens would be a violation of the ACA's aim to make healthcare affordable for all demographics.