Preventative Care Under ACA

Preventative Care and Wellness Benefits

The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements for the services. This requirement generally became effective for plan years beginning on or after Sept. 23, 2010

Coverage of Preventive Care Services

For plan years beginning on or after Sept. 23, 2010, non-grandfathered group health plans must cover certain preventive care services and may not charge copayments, coinsurance or deductibles for these services when delivered by a network provider.

The recommended preventive care services covered by these requirements are:

  • Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force;
  • Immunizations for routine use in children, adolescents and adults that are currently recommended by the Centers for Disease Control and Prevention (CDC) and included on the CDC’s immunization schedules;
  • For infants, children and adolescents, evidence-informed preventive care and screenings provided for in the Health Resources and Services Administration (HRSA) guidelines; and
  • For women, evidence-informed preventive care and screening provided in guidelines supported by HRSA (for plan years beginning on or after Aug. 1, 2012).

Women’s preventive care services

On Aug. 1, 2011, HHS issued the HRSA-supported preventive care guidelines for women to fill the gaps in the current preventive health services guidelines for women. According to HHS, these guidelines will help ensure that women receive a comprehensive set of preventive health services without having to pay a copayment, a deductible or coinsurance.

The list of recommended preventive services for women is available through HHS at: www.healthcare.gov/what-are-my-preventive-care-benefits.

According to HHS, health plans may use reasonable medical management techniques for women’s preventive care to help define the nature of the covered service, consistent with guidance provided in the interim final rules. For example, health plans may control costs and promote efficient delivery of care by continuing to charge cost-sharing for brand-name drugs if a safe and effective generic version is available. In addition, the interim final rules confirmed that plans may continue to impose cost-sharing requirements on preventive services that employees receive from out-of-network providers. Download the Preventative Care Coverage Guidelines here

BlueCross BlueShield of Tn Wellness Benefits

BCBST has followed the ACA guidelines to include comprehensive wellness and preventative benefits in all their medical plans. Benefits are available with no cost to the insured, all preventative services are covered at 100%. 

For more information about BCBSTs preventative services click here