Preventive care and federal health care reform

Update: Women’s preventive services

On August 1, 2011, the Department of Health and Human Services adopted additional guidelines for eight women’s preventive services to align with the Patient Protection and Affordable Care Act (PPACA). These specific preventive services are covered with no cost to the member at the in-network level. The guidelines are applicable to Blue Cross and Blue Shield of Minnesota commercial market products. The following document outlines these additions as part of our core benefit; some groups or groups who use a pharmacy benefit manager other than Prime Therapeutics may have a different set of preventive benefits than shown here. This change to preventive services will be effective for plans or policy years beginning on or after August 1, 2012. Groups that are in temporary safe harbor may not offer “contraceptive methods and counseling” until their plan year beginning on or after August 1, 2013. Groups that are religiously exempt may not offer “contraceptive methods and counseling” for as long as they meet the criteria for religious exemption.

Health care reform update: women's preventive services (PDF)
Exemptions and safe harbor (PDF)  

Preventive care coverage recommendations

Blue Cross has always supported preventive care as an important part of ongoing health care. That’s why most Blue Cross health plans have had comprehensive preventive care coverage for many years. We continue to communicate with our members about the changes in preventive care and encourage them to use their preventive care benefit. Depending on whether your plan(s) is/are fully or self-insured, or grandfathered, your plan(s) may or may not be affected.

The following preventive care recommendations outline the preventive services Blue Cross recommends members discuss with their provider. Please note, a recommendation does not guarantee coverage.

2013 Preventive Care Recommendations (PDF)  

For a more detailed list of preventive services that may be covered by Blue Cross, see:

Detailed 2013 Preventive Care Services (PDF)  

Preventive care coverage, according to PPACA, must be adopted according to the recommendations made by several advisory bodies:

• United States Preventive Services Task Force (USPSTF)
  
• Advisory Committee of Immunization Practices (ACIP), under the Centers for Disease Control and Prevention (CDC)
  
• Health Resources and Services Administration (HRSA) Guidelines for Preventive Care and Screenings for Infants, Children, Adolescents and Women (Bright Futures)

Inform your members

Your enrollment materials will be more important than ever, as members will be looking to see what is covered under PPACA. If some or all of your plans are grandfathered, you must also notify your members of this. Blue Cross customer service is ready to answer questions from members about their changes in coverage.

Grandfathered status

If you have chosen to maintain your current plans, you must notify your employees and covered individuals that these plans are grandfathered and are not required to follow the guidelines as set out by the new law. Special notice language must be included on all plan materials that disclose benefit information to your employees. Sample notice language (MS Word).