Under the Affordable Care Act, which item is NOT required as part of an essential benefits package?

• A. a comprehensive set of services
• B. coverage of no less than 60 percent of the actuarial value
• C. a limit on annual cost sharing by the insured
• D. stringent medical underwriting qualifications

Answer: (D)

Under the ACA, the essential benefits package is built around broad, necessary health services. Plans must provide a comprehensive set of services and meet a minimum actuarial value, typically at least 60% for bronze plans (and higher for other metal levels), so benefits cover a substantial portion of expected costs. They must also cap annual out-of-pocket costs to protect enrollees from excessive spending. Medical underwriting based on health status is not part of the essential benefits and is prohibited for ACA-compliant plans. So the item not required is the stringent medical underwriting qualifications.