Health insurers and group health plans will have to eliminate patient out-of-pocket costs for some types of preventive care services, but they may be able to use their usual rules for paying for the preventive-care office visits.
The Internal Revenue Service, the Employee Benefits Security Administration and the Office of Consumer Information and Oversight – a new arm of the U.S. Department of Health and Human Services — have announced the new rules for preventive services coverage in a batch of interim final regulations.
The regulations, which are set to appear in the Federal Register July 19, will implement a provision in the Affordable Care Act – the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) – that added Section 2713 to the federal Public Health Service (PHS) Act.
PHS Section 2713 will require all group health plans that are not “grandfathered in,” and all suppliers of individual health insurance that are not grandfathered in, to provide preventive services benefits free of cost-sharing requirements.
Group or individual health insurance arrangements purchased or changed significantly after March 23, 2010, must provide benefits for:
- Preventive services that receive top marks from the U.S. Preventive Services Task Force.
- Immunizations recommended by the U.S. Centers for Disease Control and Prevention immunization practices advisory council.
- The preventive care and screenings recommended for babies, children and adolescents by the federal Health Resources Services Administration (HRSA).
- The preventive care and screening recommended for women that will be described in guidelines to be developed by Aug. 1, 2011.