As you may know, the health care reform law includes a provision requiring health insurers to cover preventive services with no member cost sharing. Recently-published interim final regulations clarify this provision. Non-grandfathered plans issued or renewed on or after September 23, 2010, will not include member cost sharing or copays for the following preventive care provided in-network:
- Evidence-based items or services that have a rating of A or B in the current recommendations of the United States Preventive Services Task Force.
- Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
- For infants, children and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
- For women, to the extent not otherwise addressed by the United States Preventive Services Task Force recommendations, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.
Other key points:
- This impacts non-grandfathered plans issued or renewed on or after September 23, 2010.
- This applies to in-network services. Out-of-network services will have the same cost-sharing requirements as they do today.
- Most of the recommended screenings, immunizations and exam services are already on our preventive services list.
- An example of a new preventive service is counseling related to aspirin use, tobacco cessation, obesity and alcohol use.
- Some services currently covered as medical/maternity will now be considered preventive services. This includes several recommended screenings for pregnant women.