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Frequently Asked Questions Insurance

What benefits are covered in plans sold in the DC SHOP?

Beginning in 2014, all new SHOP plans must cover a comprehensive package of "essential health benefits" (EHB). DC SHOP’s benefits are based on those covered in the most popular small group health insurance policy currently sold in the District market. The benefits cover:

  • Doctor visits
  • Hospital stays
  • Emergency room care
  • Maternity and newborn care
  • Prescription drugs
  • Lab tests
  • Preventive tests and services
  • Rehabilitative and habilitative services and devices
  • Chronic disease management
  • Mental health care
  • Substance use disorder services
  • Dental care for children
  • Vision care for children

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