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Health Care Reform Update: Preventive Care Rules Clarified

New regulations were issued on July 14, 2010, by The Department of Health and Human Services (HHS), the Department of Labor, and the Treasury regarding preventive care coverage requirements.  The HHS estimates that Americans currently use preventive services at about half of the recommended rate, due to the cost of these services.  According to the HHS, the intention of these regulations is to make preventive care more affordable, so that chronic diseases, which are often preventable, can be detected and treated or prevented early, thereby reducing healthcare costs and promoting health and wellness.

Health plans that are not “grandfathered plan” will be required to include preventive care services beginning with plan years renewing after September 23, 2010, which would be January 1, 2011 for plans that renew each calendar year.  Grandfathered plans, which are plans that have not made certain substantial changes to plan design or costs will not have to meet this preventive care requirement.

The covered preventive services would be available at no cost to the employee.  In other words, these services are not subject to a deductible, co-pay, or co-insurance, and would be covered 100% by the health plan, as long as they received services from an in-network provider.  Plans are still allowed to share the cost of preventive services provided by an out-of-network provider.

Included in the preventive services are:

  • Screenings for diseases such as cancer, diabetes, high cholesterol, and high blood pressure
  • Vaccines for both children and adults
  • Pediatric care
  • Prevention for women including pregnancy related screenings and mammograms.

For further information about the new preventive care rules, please visit www.healthcare.gov

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