What are Habilitative Services?

By January 22, 2018HEALTH INSURANCE
habilitative services

What are Habilitative Services?

Most of us are familiar with the term rehabilitative services, as it forms part of any health insurance essentials package offered by our health insurers. A typical example of rehabilitative services is undergoing physiotherapy after an accident. However, few of us have even heard of another health insurance essential known as habilitative services, unless we happen to be parents of chronically ill children.

Health Insurance Essentials Unpacked

If your employer does not provide healthcare benefits or if the program does not cover your spouse and children, you need to purchase a separate insurance that covers health insurance essentials. A certain coverage is straightforward, but there are pockets of ignorance that can affect consumers. One of these is habilitative services – the list also includes:


-Ambulance/emergency services

-Pediatric services including dental and vision care

-Services for mental health disorders and substance abuse

-Rehabilitative and habilitative services

-Maternity and newborn care

-Prescription drugs

-Disease screening

-Lab tests

Habilitative Services in Focus

Habilitative therapy is an acknowledged form of treatment that aims to assist patients to develop skills or functions that they seem incapable of developing on their own. The provision of habilitative services is quite common for pediatric patients who, compared to their peers have yet to develop certain skills at an appropriate level for their age.

Case in Point

This hypothetical scenario illustrates where habilitative therapy would certainly apply:

Imagine a parent receives a report from a teacher about their 6-year-old boy concerning the child’s behavior in the classroom. Specifically, the toddler seems unable to remain seated through lessons and displays boundless energy levels. Moreover, he is inclined to influence and disrupt classmates.

In the circumstances, the parent decides to consult a behavioral psychologist. After being diagnosed with ADHD, the health professional formulates a treatment plan for the youngster. The treatment program devised for the 6-year old falls in line with therapy administered under habilitative services. This is because, unlike his peers, the child seems unable to develop the skills required to remain focused in a classroom situation.

Remember, it is always a good idea to understand your health insurance and to seek the advice of your insurance broker if anything is unclear regarding habilitative services.

Affordable Care Act Rulings

The Affordable Care Act (ACA) broadens and strengthens the health insurance benefits available to consumers, by requiring insurers to provide coverage of a minimum set of medical services known as “essential health benefits.” This includes rehabilitative and habilitative services.

Federal officials implemented this reform using transitional policies that left many important decisions to individual states. It seems significant variation now exists in how individual states have implemented their essential health benefits packages. This includes official approaches to benefit substitution and coverage of habilitative services.

Assessing your Habilitative Services Needs

As with all insurance products, as the coverage is as good as its weakest link. This invariably rests with the interpretation of policy exclusions. Make sure you know what is – and is not – covered when you arrange insurance cover. Better still; speak to your friendly insurance broker.

Hotwire Insurance Services, a full-service independent agency, works for you and not insurance companies and does not charge a broker’s fee. Hotwire Insurance Services local agents can answer all your insurance requests.

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