Insurance One Management, Inc.

Preventive Benefit Changes and Your Health Plan under PPACA:

In Health Care Reform, Preventive Care on February 3, 2011 at 6:03 pm

The Patient Protection and Affordable Care Act (PPACA) requires most group health plans that are not “grandfathered” to cover certain evidence-based preventive services with no copayments or cost-sharing. This includes screenings, check-ups and patient counseling to prevent illnesses, disease or other health problems.

Covering preventive care services with no cost-sharing sounds like a good idea. Allowing your employees to schedule annual exams or certain screenings without having to pay out-of-pocket could encourage more of them to do so.

In theory, the increase in preventive services will lower healthcare costs in the long term, by catching certain illnesses and conditions early, when treatment costs less. However, nothing is really free. Experts estimate the cost of covering these preventive care services with no cost-sharing—along with the additional treatments and follow-up care likely to result—will add another 1 to 3 percent to your group health premiums.

News stories, healthcare providers and others are telling the public that healthcare reform laws require group and individual insurance plans to cover preventive treatments with no deductible, co-payment or coinsurance. They may fail to explain that this requirement doesn’t apply to grandfathered plans, those already in existence when the PPACA was enacted on March 23, 2010. If your organization’s plan is grandfathered and does not waive cost-sharing for preventive treatments, you will need to educate your employees.

The PPACA does not address instances when there are changes to the insurance carrier offering the plan (e.g., new corporate owner); it is not clear whether organizational changes would make grandfathered plans into new plans. If any of these changes have occurred to your organization’s plan, please check with your carrier or contact us—the preventive care and other provisions of the PPACA might apply. We can also help with employee benefit education—please contact us for more information.

What’s Covered

What preventive care services qualify for coverage with no cost-sharing under healthcare reform?

The preventive care provisions of the PPACA give insureds under qualifying group plans “free” access to preventive services such as:

  • Blood pressure, diabetes and cholesterol tests;
  • Many cancer screenings, including mammograms and colonoscopies;
  • Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating  depression and reducing alcohol use;
  • Routine vaccinations against diseases such as measles, polio or meningitis;
  • Flu and pneumonia shots;
  • Counseling, screening and vaccines to ensure healthy pregnancies;
  • Regular well-baby and well-child visits, from
    birth to age 21.

Availability of benefits might vary depending on age, gender and other risk factors.

__________________________________________________________________________________

The information presented and conclusions within are based solely upon our best judgment and analysis.  It is not guaranteed information, but is intended to provide accurate and authoritative information in regard to the subject matter covered.  It does not necessarily reflect all available data, and is provided with the understanding that we are not rendering legal, accounting, or tax advice.  Any web links/addresses are current at time of publication but subject to change.  This material is being reproduced with the permission of the publisher via a paid subscription by Insurance One Management, Inc. dba Don Crawford & Associates, Midland, TX.

©2011 Smart’s Publishing – Employee Benefits Report – Volume 9, Number 2 – All Rights Reserved. – Website: http://www.smartspublishing.com

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