Health Care Reform Legislation Guidance Issued on Coverage of Preventive Health Services

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Health Care Reform Legislation Guidance Issued on Coverage of Preventive Health Services Applicable to Non-Grandfathered Health Plans. The Rule, which implements Section 2713 of the Patient Protection and Affordable Care Act (the “Affordable Care Act”), Pub. L. 111-148, requires non-grandfathered plans to cover certain preventive care services, and prohibits imposition of any cost-sharing requirements if the services are delivered by an in-network provider. The Rule is effective for the first plan or policy year beginning on or after September 23, 2010.

The most significant aspect of the Rule is that a plan is prohibited from imposing a co-payment, co-insurance, or deductible with respect to the following services:

• Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;

• Preventive care and screenings for children recommended by the Health Resources and Services Administration;

• Preventive care and screenings for women recommended by the Health Resources and Services Administration; and

• Services recommended by the United States Preventive Task Force, an independent panel of experts in primary care and prevention appointed by HHS that reviews the evidence of effectiveness and develops recommendations for preventive services.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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