Background

On July 19, 2010 the tri-agency task force1 charged with drafting regulations under the Patient Protection and Affordable Care Act (PPACA) published interim final regulations implementing PPACA’s preventive care coverage and cost-sharing requirements for group and individual health plans. The new preventive care requirements do not apply to grandfathered group or individual health plans. However, grandfathered plans that choose to implement the new preventive care requirements may do so without jeopardizing the plan’s grandfathered status.

The rules clarify the application of PPACA’s first-dollar preventive care coverage requirements, which are effective as of the first day of the first plan year beginning on or after September 23, 2010 (Effective Date). Specifically, the rules: (1) specify the four categories of preventive care services and items that a plan is required to cover – all of which must be covered without cost-sharing; (2) explain the timing for adopting future changes to the plan’s preventive care coverage based on changes to the applicable regulations or guidelines within the four categories; and (3) explain when the plan may, and may not, require cost-sharing for an office visit associated with a preventive care visit.