Preventive Care Services
Non-Grandfathered Plans (beginning on or after September
23, 2010)
If you have a new health insurance plan or insurance
policy effective on or after September 23, 2010, visit
healthcare.gov preventive services for a list of covered
preventive services.
Preventive services are to be covered without any cost-sharing
requirement.
- For plans with both in and out-of-network coverage, the
cost-sharing requirement applies to in-network coverage only.
- Plans without a network (e.g. indemnity plans) must cover
preventive care at 100%.
The regulation references preventive care services outlined by
the United States Preventive Services Task Force with an A or B
rating. They can be found at:
healthcare.gov preventive care services.
If a guideline for a recommended preventive service does not
specify the frequency, method, treatment, or setting for the
service, the plan or issuer may use "reasonable medical management
techniques" to determine any coverage limitations on the
service.
As new or updated preventive care recommendations or guidelines
are issued, employers and insurers have one year to implement the
new guidelines.
Plans that cover preventive services in addition to those
required may apply cost-sharing requirements for the additional
services.
Grandfathered Plans
If you have a health insurance plan that is grandfathered, the
covered services and cost sharing benefit requirement will be
maintained as they are today and as outlined in your benefit
booklet certificate.