Human Resources News & Insights

New list of 8 preventive services plans must cover for women

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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Comments

  1. Does anyone know if these will be (or I should say, when these will be) tacked on to grandfathered plans?

  2. Common Sense says:

    Can the insured not have at least some skin in the game so the system does not get abused. Is a $10 copay to much to ask someone to pay a doctor for their time. The entire law is a house of cards that interferes with the supply and demand forces to the point where doctor and hospital shortages are inevitable consequences.

  3. I agree that having a copay makes an employee more judicial in determining a more cost efficient approach to their health. However, being that the things that are listed are very difficult to abuse – how do you abuse getting tested for HPV or an annual visit (it can only be done annually)? Just a reminder that not everyone’s copay is just $10 especially for contraceptives (mine is $35/month – I work for a small business). The doctors will still be compensated for their service but now the insurance just has to cover the services entirely with the money we pay them. If anything it is in the insurance companies’ best interest to provide better preventative coverage as in the end it saves them money from more costly issues that didn’t get detected early. In the past they didn’t care about utilizing preventative care to reduce their costs, rather they focused on finding ways to just evade having to pay. Do you really want your health dictated by supply and demand? Ignoring that many people are not able to afford the demand (due to losing their jobs) is the part that the law is trying to resolve. It is not interfering with the doctor’s and hospital’s compensation. It in the end should help the shortages since it is an attempt to avoid increases in diseased people that have to go to the hospital because they were avoiding the cost of preventative care and playing roulette with their lives. The insured’s skin in the game is the increasing cost of insurance. My company’s insurance premium increased by 35% (wish this was an exageration) this year due to an employee getting cancer treatment. This increase was even though the insurance company has a 42% net profit (actual figure, I requested the information from them) from the last 5 years we have been with them. They were kind enough to drop the increased quote by 2%. Does your company have that kind of net per customer?

  4. Common Sense says:

    Raquel, your anectdotal evidence is almost totally meaningless. One insurance company has a 42%net profit from one client does not mean this is an average for the industry. The health insurance industry consistently ranks as having one of the lowest profit margins at less than 6%. Your premiums have gone up 35% because the company knows that they will probably lose money with the cancer patient if they don’t. There are always other insurance carriers your business can turn to if you think you are getting gouged. By the way, you say “The doctors will still be compensated for their service…It is not interfering with the doctor’s and hospital’s compensation. It in the end should help the shortages…” I know liberally minded people like to believe this utopian view, but it is absolutely false. When/if the reform law is fully implemented (God forbid) the law will dictate how much the doctors and hospitals will be compensated and there will be shortages. We see ample evidence of this already in the medicare market, where many doctors are already refusing medicare patients. As the matter of fact, part of the reason your healthcare premiums are so high right now is that doctors and hospitals overcharge the private market to recoup the losses they incur from the artificially low medicare payments.

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