Essential Health Benefits in West Virginia are divided into ten categories of services. These categories must be included in the services offered by a health insurance plan or insurer for that plan to participate in the health insurance exchange marketplace in West Virginia. The categories of essential health benefits include • ambulatory patient services • emergency services • hospitalization • maternity and newborn care • mental health services • prescription drugs • rehabilitative and habilitative services • laboratory services • preventive, wellness, and chronic disease management service • pediatric services including vision and dental To place a cap on cost-sharing, maximum deductibles and out-of-pocket maximums were established. For 2016, the maximum deductible is $2,000 for an individual and $4,000 for a family. The out-of-pocket maximum in 2016 is $6,850 for an individual and $13,700 for families. The offering of four tiers of coverage provides the standardized benefit plan design: • bronze — pays 60% of full actuarial value for claims • silver — pays 70% of full actuarial value for claims • gold — pays 80% of full actuarial value for claims • platinum — pays 90% of full actuarial values for claims These plans are often referred to as the “metal” plans. The tables below show a example of the exchange benefit plan designs for the metals plans for two different state exchanges. Table Comparison of Bronze Tier Plans Benefit Sample State 1 State 1 State 2 Standard Bronze Plan Bronze HSA Plan (in network) Standard Bronze Plan Deductible (Individual) $5,000 Medical and Rx — combined $4,500 Medical and Rx — combined $3,000 individual Out-of-pocket limit $6,350 — individual $6,350 — individual $6,350 — individual Primary care office visit $60** 40%* 50% * Specialist visit $70 40%* 50% * Inpatient hospitalization 30%* 40%* 50%* Preventive care no cost share Lab in PCP office 30%* 40%* 50% * X-ray in PCP office 30%* 40%* 5. Call Songer Benefits in West Virginia for the best health insurance available.