Health care reform includes a provision for first dollar coverage for preventative care. On August 3, the EBSA release some Interim Rules on coverage for preventative care and left them open for comment before they become final. There are provisions for immunizations, child care and preventative screenings for women to be developed by the Health Resources and Services Administration.
Coincidentally, on August 1, 2011, the Department of Health and Human Services issued that one of its agencies, the HRSA, will be adopting guidelines that will apply to non-grandfathered plans as of the first plan year starting on or after August 1, 2012. So if your plan operates on a calendar year, the guidelines would apply on January 1, 2013.
Under the new guidelines, 8 categories of services and supplies are listed as "preventative" that must be given the 100% coverage:
- Contraceptive methods and counseling (with a narrow exception for religious institutions);
- Well-woman visits;
- Screening for gestational diabetes;
- Human papillomavirus testing;
- Counseling for sexually transmitted infections;
- Counseling and screening for human immune-deficiency virus;
- Breastfeeding support, supplies (such as breast pump rental), and counseling; and
- Screening and counseling for interpersonal and domestic violence.
- Medical management still permissible.
You can check out the HRSA website for more details.
This is not to suggest that something has to be done immediately. But plan sponsors who are designing plans and looking at long-term implementation should be clearly aware of the expansion of not just these services, but the likelihood of further definitions of "preventative care" being provided. So it is important to make sure you keep up to date on the various definitions and requirements of full compliance.