Tip Tuesday: New list of 8 preventive services plans must cover for women

August 12, 2011 by Christian Schappel

A few more preventive medical services were tacked on to the list non-grandfathered health plans must fully cover for participants.
The set of women’s preventive services — which was developed by the Institute of Medicine — that was added to the list of services plans must cover 100% under the healthcare reform law:

1. FDA-approved contraceptive methods, sterilization procedures, education and counseling for all women with reproductive capacity
2. Annual well-women visits (and any additional visits deemed necessary)
3. Screening for gestational diabetes
4. Human papillomavirus testing
5. Counseling for sexually-transmitted infections
6. HIV counseling and screenings
7. Breastfeeding support, supplies and counseling, and
8. Screening and counseling for domestic violence.

Background

The healthcare reform law tasked a consortium of government agencies with determining which medical services actually fall under “preventive.”

Beginning Aug. 1, 2012 (Jan. 1, 2013 for calendar-year plans), anything listed must be covered with no charge to a patient via a copayment, coinsurance or deductible when the services are performed by a network provider.

And rather than spell these services out, the feds are asking health plan administrators to refer to an array of continuous recommendations by these agencies. 

Some of the preventive services that must be covered without cost-sharing arrangements for all employees include:

• Routine immunizations of children, adolescents or adults — for things like Influenza, Hepatitis A & B, and
• Screenings — for things like high blood pressure, HIV, diabetes, hearing loss, etc.

The guidelines for what services must be covered will be updated on an ongoing bases, and health plans are required to comply with any changes in plan years beginning the year after the changes are published.

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