Preventive care requirements still evolving

September 2011

The mandate for health plans to cover 100% of the cost of preventive care did not originally specify what care would be covered, and this past summer the government issued new guidance.

The Department of Health and Human Services released additional Guidelines for Women’s Preventive Services in August. This means health care providers must pay for the following: well-woman visits, breastfeeding equipment, contraception, and domestic violence screening.

Right now, these must be covered in new health plans starting in August 2012; however, the requirements are subject to a public comment period and may be expanded or changed.

These are in addition to the interim regulations issued in September 2010, which list a variety of covered care, from colorectal, cervical and breast cancer screenings to tobacco cessation assistance.

Only grandfathered health plans do not have to comply with this mandate.

The government’s preventive care website is a good resource for the latest developments in this evolving portion of the law.

Impact on employers — If they use these no-cost preventive services, employees will be more likely to catch serious problems early on. This can reduce health care costs down the road for a company and its workers.

Impact on employees — This will depend greatly on whether they embrace these free preventive services. If usage is high, early intervention for certain health conditions can translate to better health and lower medical expenses.