The Affordable Care Act contains a provision to make certain preventive services available without co-pays, co-insurance or deductibles.
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 (copayments, coinsurance or deductible) requirements as long as services are rendered by physicians and other health care professionals who participate in the plan’s network.
This preventive services provision applies to both fully insured and self-funded plans. While grandfathered plans are not required to implement these changes, some grandfathered plans have chosen to offer preventive care services at no cost-share.
Additional preventive care services for women will be covered as part of the health reform law effective on the health plan’s first renewal date on or after Aug. 1, 2012. For information on the expanded list of women’s preventive coverage, please read UnitedHealthcare’s Approach to Women’s Preventive Care Services (PDF).
In addition to services mandated by the health reform law, UnitedHealthcare also applies preventive care services benefits to certain services above and beyond the health reform law’s requirements including colorectal cancer screening using CT colonography, prostate-specific antigen (PSA) screening for prostate cancer, and mammography screening for all adult women. These services are marked below with an asterisk.*
The following guidelines for women were effective for plan years beginning on or after Sept. 23, 2010:
New coverage guidelines under the Patient Protection and Affordable Care Act (PPACA) require health plans to cover an expanded list of women’s preventive care services with no cost-share (copayment, coinsurance or deductible) as long as services are received in the health plan’s network. Coverage for the following expanded women’s preventive care services becomes effective the first plan year beginning on or after Aug. 1, 2012:
It is important to note that for renewing fully insured plans, the effective dates for medical coverage and pharmacy coverage for expanded women’s preventive care services may be different. Medical coverage begins on the fully insured plan’s first renewal date on or after Aug. 1, 2012, and pharmacy coverage begins on Aug. 1, 2012, regardless of the plan’s renewal date as long as the group has oral contraceptive coverage today. For all other new or renewing plans, pharmacy and medical coverage becomes effective as of the first plan year, or the first health plan renewal date, on or after Aug. 1, 2012.
The Department of Health and Human Services has defined the preventive services to be covered with no cost-share as those services described in the U.S. Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by the Health Resources and Services Administration (HRSA) Guidelines including the American Academy of Pediatrics Bright Futures periodicity guidelines.