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.