The Affordable Care Act requires non-grandfathered health plans and health insurance issuers to provide coverage for preventive care services without any cost sharing. This means that copayments, coinsurance or deductibles cannot be imposed on the services considered "preventive care" under health care reform. All plan sponsors must be aware of these requirements, as they apply to both fully insured and self funded health plans.
For insured plans, additional preventive care services for women must be covered as of the plan's first renewal date on or after August 1, 2012. The benefits requiring coverage are based on recommendations from the Institute of Medicine, and reflect services required for women's health.
Specifically, the services that must be covered include
- Well-women visits
- Screening for gestational diabetes
- HPV testing
- Counseling for sexually transmitted infections
- Counseling and screening for HIV
- Breast feeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
- Contraceptive methods and counseling.
Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services. Other preventative services, including mammograms to screen for breast cancer in women over 40, are already required to be covered under health plans without cost sharing.
Increased coverage for preventive services, including services for women, are generally welcomed as necessary for women's health and well-being.
