Healthcare Reform Update: Coverage Without Cost-Sharing of Preventive Services

• Current preventive recommendations per the US Task Force.
• Immunizations for routine use in children, adolescents, and adults
• Preventive care and screenings for infants, children, and adolescents
• Preventive care and screenings for women – (complete list still being developed by HHS)

There are other guidelines on the waiting list to also be considered preventive services. (When a recommendation or guideline is issued, there is at least a one-year interval before the guideline applies to the plan year to be a covered preventive service.)  Click here to see a list of recommended preventive services.

There may be instances where cost-sharing may still required for office visits. For example:

• If a recommended preventive service is billed separately from an office visit, the insurer may impose cost-sharing requirements with respect to the office visit.
• If a recommended preventive service is not billed separately from an office visit and the primary purpose of the office visit is not the preventive service, a plan or insurer may impose cost-sharing requirements for the office visit.

An out-of-network provider may also impose cost-sharing requirements for recommended preventive services administered by an out-of-network provider.

If a recommended preventive service does not specify the frequency, method, treatment, or setting for the provision of that service, the plan or insurer can use reasonable medical management techniques to determine any coverage limitations.

For help in understanding this or any segment of healthcare reform, please contact your Human Resources Consultant at 888-810-8187.