The Affordable Care Act contains a provision to make certain preventive services available without co-pays, co-insurance or deductibles.
The following information comes compliments of UnitedHealthcare. This simple video helps explain important topics for understanding the Health Reform Provisions.
Summary
A non-grandfathered group health plan and a health insurance issuer offering group or individual health insurance coverage must provide coverage for preventive care without any cost-sharing requirements.
Preventive care services* include:
All members
- Yearly preventive medicine visits (Wellness visits)
- All standard immunizations recommended by the American Committee on Immunization Practices
All members at an appropriate age or risk status
- Screening for colorectal cancer, elevated cholesterol and lipids
- Screening for certain sexually transmitted diseases and HIV
- Screening and counseling in a primary care setting for alcohol or substance abuse, tobacco use, obesity, diet and nutrition
- Screening for high blood pressure, diabetes and depression
Women’s health
Recently, the Department of Health and Human Services released new health plan coverage guidelines that will require health insurance plans to cover women’s preventive services without charging a copayment, coinsurance or a deductible effective for plans beginning or renewing Aug. 1, 2012, to now include:
- Well-woman visits
- Screening for gestational diabetes for all pregnant women
- Human papilloma virus DNA testing for all women 30 years and older
- Annual sexually transmitted infection counseling for all sexually active women
- Annual counseling and screening for HIV for all sexually active women
- FDA-approved contraception methods, sterilization procedures and contraceptive counseling
- Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
- Domestic violence screening and counseling
The following guidelines were effective for plan years beginning on or after Sept. 23, 2010:
- Screening mammography and evaluation for genetic testing for BRCA breast cancer gene
- Screening for cervical cancer including Pap smears
- Screening for gonorrhea, Chlamydia, syphilis
- Screening pregnant women for anemia, iron deficiency, bacteriuria, hepatitis B virus, Rh incompatibility
- Promotion of and counseling for breast-feeding
- Osteoporosis screening (age 60 and older)
- Counseling women at high risk of breast cancer for chemoprevention
Men’s health
- Screening for prostate cancer for men (age 40 and older)
- Screening for abdominal aortic aneurysm in men (age 65-75)
Children
- Screening newborns for hearing, thyroid disease, phenylketonuria and sickle cell anemia
- Standard metabolic screening panel for inherited enzyme deficiency diseases
- Counseling for fluoride treatment
- Screening for major depressive disorders
- Vision screening
- Screening for developmental/autism screening
- Screening for lead and tuberculosis
- Counseling for obesity
*The US Department of Health and Human Services has defined the preventive services to be covered with no cost share as those services described in the United States Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and HRSA Guidelines including the American Academy of Pediatrics Bright Futures periodicity guidelines.