Preventive Health

Federal authorities answered a common question about women’s preventive services guidelines in “FAQs about Affordable Care Act Implementation Part 35,” which was released on Dec. 20, 2016, by the U.S. Departments of Labor, Health and Human Services and the Treasury. The question and a summarized answer is below.

Q: The Health Resources and Services Administration (HRSA) updated its Women’s Preventive Services Guidelines on Dec. 20, 2016. When must non-grandfathered group health plans and health insurance issuers begin offering coverage for preventive services without cost sharing based on the updated guidelines?
A: Women’s preventive services are required to be covered without cost sharing in accordance with the updated guidelines for plan years (or, in the individual market, policy years) beginning on or after Dec. 20, 2017. Until the new guidelines become applicable, non-grandfathered group health plans and health insurance issuers are required to provide coverage without cost sharing consistent with the previous HRSA guidelines and the Public Health Service Act section 2713 for any items or services that continue to be recommended.

Follow this link to view a side-by-side comparison of the new HRSA guidelines with the ones in effect prior to those for plan years on or after Dec. 20, 2017. Based on recommendations developed by the Women’s Preventive Services Initiative, the updated guidelines complement and build upon recommendations from organizations such as the U.S. Preventive Services Task Force.

Follow this link for the complete FAQ document.

The Affordable Care Act (ACA) introduced changes to how many self-insured health plans cover preventive services.

More on preventive health
The legislation’s provisions on preventive health coverage began affecting non-grandfathered health plans for plan years beginning on or after Sept. 23, 2010. The ACA requires non-grandfathered health plans to provide 100 percent coverage for certain preventive services and immunizations provided by a network doctor or hospital. Cost-sharing requirements, such as copayments, deductibles or coinsurance, are prohibited for preventive health provided by a network healthcare provider. However, such health plans are not required to provide coverage for preventive services from non-network hospitals and doctors, and they may impose a cost-sharing requirement when the services are provided out of network.

Contraceptive services
For plan years on or after Aug. 1, 2012, the ACA requires non-grandfathered health plans to provide coverage for contraceptive services to women without cost-sharing. However, through a series of regulations and guidance documents, exceptions have been made for “religious employers” and “eligible organizations.”

To learn more about preventive benefits, read: