Preventive care and federal health care reform

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 preventive care services at no cost to the covered individual. See Blue Cross’ preventive care coverage guidelines to find out which preventive services will be covered under the new law.

Preventive care coverage 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

What has changed?

New preventive care services have been added based on input from several industry groups. Examples of these are:

  • Screening, counseling and behavioral interventions for obesity in adults
  • Screening for major depressive disorders in adolescents
  • Prescribing of oral fluoride for children to prevent dental caries (if water is found low in fluoride)

Depending on whether your plan(s) is/are fully or self-insured, your plan(s) may or may not be affected.

When does preventive care coverage change?

The law is in effect for coverage issued or renewed on or after September 23, 2010. Generally speaking, for those with employer-sponsored coverage, your preventive care coverage may change once the plan renews after September 23, 2010. Preventive care coverage for individuals should expect the enhanced preventive care benefit for those renewing after September 23.

Inform your members

Your enrollment materials will be more important than ever, as members will be looking to see what is covered under the new law. 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 do not 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).

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