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SEPTEMBER 2011

New Requirement 2012: Summary of Benefits and Coverage

Affordable Care Act Ensures Insurers and Plans Provide Simple Summaries of What is Covered and What You Pay for Health Services. Download the full article here.



Affordable Care Act Expands Prevention Coverage for Womens Health and Well-Being

From Healthcare.gov
http://www.healthcare.gov/center/regulations/womensprevention.html

The Affordable Care Act the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services and by eliminating cost sharing. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, co-insurance or deductible for these services when they are delivered by a network provider.

Learn more about the recommended preventive services available to Americans without cost sharing.

Womens Preventive Services: Required Health Plan Coverage Guidelines

Under the Affordable Care Act, womens preventive health care services such as mammograms, screenings for cervical cancer, and other services are covered with no cost sharing for new health plans. However, the law recognizes and HHS understands the need to take into account the unique health needs of women throughout their lifespan.
The Health Resources and Services Administration-supported health plan coverage guidelines for womens preventive services below, developed by the Institute of Medicine (IOM), will help ensure that women receive a comprehensive set of preventive services without having to pay a copayment, co-insurance, or a deductible. HHS commissioned an IOM study to review what preventive services are necessary for womens health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. HRSA is supporting the IOMs recommendations on preventive services that address health needs specific to women and fill gaps in existing guidelines.

Learn more about the Affordable Care Act and the Guidelines for Womens Preventive Services

Health Resources and Services Administration-Supported Women's Preventive Services: Required Health Plan Coverage Guidelines

These guidelines are effective August 1, 2011. Accordingly, non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

Well-woman visits

HHS Guideline for Health Insurance:
Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.

CoverageFrequency:
Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a womans health status, health needs, and other risk factors.*

Screening for gestational diabetes

HHS Guideline for Health Insurance:
Screening for gestational diabetes.

CoverageFrequency:
In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.

Human papillomavirus testing

HHS Guideline for Health Insurance:
High-risk human papillomavirus DNA testing in women with normal cytology results.

CoverageFrequency:
Screening should begin at 30 years of age and should occur no more frequently than every 3 years.

Counseling for sexually transmitted infections

HHS Guideline for Health Insurance:
Counseling on sexually transmitted infections for all sexually active women.

CoverageFrequency:
Annual.

Counseling and screening for human immune-deficiency virus.

HHS Guideline for Health Insurance:
Counseling and screening for human immune-deficiency virus infection for all sexually active women.

CoverageFrequency:
Annual.

Contraceptive methods and counseling.**

HHS Guideline for Health Insurance:
All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.As prescribed.
Breastfeeding support, supplies, and counseling.Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.In conjunction with each birth.
Screening and counseling for interpersonal and domestic violence.Screening and counseling for interpersonal and domestic violence.

CoverageFrequency:
Annual.


* Refer to recommendations listed in the July 2011 IOM report titled Clinical Preventive Services for Women: Closing the Gaps concerning individual preventive services that may be obtained during a well-woman preventive service visit.

** Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services. A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii). 45 C.F.R. 147.130(a)(1)(iv)(B). For more information, read the amendment to the interim final rule http://www.ofr.gov/OFRUpload/OFRData/2011-19684_PI.pdf.