Preventive care and federal health care reform
Update: Women’s preventive services
On August 1, 2011, the Department of Health and Human Services, per the PPACA, adopted additional guidelines for eight women’s preventive services. 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. This is 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.
Preventive care coverage guidelines
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.
One of the provisions of the Patient Protection and Affordable Care Act, otherwise known as the federal health care reform bill, requires most plans to cover certain preventive care services at no cost to the covered individual.
See Blue Cross’ preventive care coverage guidelines to find out which preventive services may be covered under the new law:
Depending on whether your plan(s) is/are fully or self-insured, or grandfathered, your plan(s) may or may not be affected.
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
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.
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).