"320 (such as Tricare ). Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service . • Essential health benefits must be provided. The National Academy of Medicine defines the law's \"essential health benefits\" as \"ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; pr escription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care\" and others rated Level A or B by the U.S. Preventive Servic es Task Force. In determining what would qualify as an essential benefit, the law required that standard benefits should offer at least that of a \"typical employer plan\". • Additional preventive care and screenings for women. This includes Well - woman visits, gestational diabetes screening for pregnant women, domestic and interpersonal violence screening and counseling, FDA - approved contraception methods, and contraceptive education and counseling, breastfeeding support, supplies, and counseling, HPV DNA testi ng, for women 30 or older, sexually transmitted infections counseling, and HIV screening and counseling for sexually - active women. This mandate applies to all employers and educational institutions except for religious organizations. These regulations were included on the recommendations of the Institute of Medicine. • Annual and lifetime coverage caps on essential benefits were banned. • Prohibits insurers from dropping policyholders when they get sick. • All health policies sold in the United States must provi de an annual maximum out of pocket (MOOP) payment cap for an individual's or family's medical expenses (excluding premiums). After the MOOP payment cap is reached, the insurer must pay all remaining costs. • Preventive care, vaccinations and medical screenin gs cannot be subject to co - payments, co - insurance or deductibles. Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contr aceptive methods, breastfeeding support/supplies and domestic violence screening and counseling. • The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out - of - pocket costs: bronze plans have the lowest monthly premiums and highest out - of - pocket costs, while platinum plans are the reverse. The percentages of health care costs that plans are expected to cover through premiums (as o pposed to out - of - pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum). • Insurers are required to implement an appeals process for coverage determination and claims on all new plans."