Free Legal Insights White Paper

The Affordable Care Act: Mandated Benefits Compliance Standards

A detailed summary of the health insurance benefits a plan must provide.

The Patient Protection and Affordable Care Act requires individuals who do not receive coverage from an employer or other entity to obtain coverage themselves. That insurance must provide coverage for a defined set of essential services.’s The Affordable Care Act: Mandated Benefits Compliance Standards discusses the minimum benefits that an ACA compliant health insurance plan must provide.

Major Legal Insights Covered in this white paper:

  • Reviewing the framework of the Affordable Care Act
  • Explaining the essential health benefits a compliant insurance plan must provide
  • Listing the criteria used for the official determination that a plan is in compliance
  • Explaining the benchmarks used for measuring compliance
  • Listing the benchmark insurance plans in each state

Table of Contents



  • Historical Background
  • Universal Coverage
  • State Universal Coverage Legislation
  • Enactment of the Patient Protection and Affordable Care Act
  • Essential Provisions of the ACA
  • Individual Mandate
  • Employer Mandate
  • Other Provisions
  • Impact of the ACA


  • Benefits that Must be Provided
  • Non-required Coverage
  • Tiers of Compliant Plans


  • State Enforcement
  • Federal Enforcement
  • Private Rights of Action



  • State Benchmark Plans for Essential Health Benefits, 2014 – 2016


  • Further Reading
  • Statutes and Regulations
  • Comparative and Historical Analysis
  • Overview of ACA
  • Essential Health Benefits
  • Economics of the ACA


  • Figure 1. Federal Legislative Background
  • Figure 2. ACA Fee Limits
  • Figure 3. Change in Insurance Rates 1960-Present

About the Authors

Randall Holbrook, Senior Research Attorney at, has worked as an attorney in private practice and as corporate counsel. His work encompasses a wide range of fields, including insurance and healthcare law, medical and tort litigation, and employment issues. For’s highly regulated industry clientele, Randall focuses on legislative and regulatory monitoring and analysis across all fifty states and on the federal stage. He is a graduate of Hamline University School of Law.

Heather Menard, Research Attorney, graduated with honors from UCLA School of Law, after which she became a litigation attorney with Sidley Austin. As a litigator and in her current compliance-centered role, Heather has worked with a range of legal issues, including contract law, constitutional claims, consumer protection, unfair business practices, employment law, accountant liability, and securities litigation.

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