Plans will have to provide some preventive services at no cost

Beginning September 23rd, new health plans will have to provide a wide range of preventive services at no additional cost to enrollees, the Department of Health and Human Services announced Wednesday.

Under the regulations, authorized by the new health reform law, plans launched on and after September 23rd will  be required to cover such preventive services as cholesterol, blood pressure and diabetes tests, cancer screening and routine immunizations without additional charges, such as copayment.

Chronic diseases, such as heart disease, diabetes and cancer, are responsible for 7 in 10 death in the U.S., the government said, an account for 75 percent of U.S. health spending.

Many of these conditions are preventible or more easily and cheaply treated if caught and treated early, the government said.

Immunization, for example, is one of the most cost-effective ways to prevent disease, yet 11 million children and 59 million adults are in private health plans that do not adequately cover immunizations, the government said.

According to public health experts, Americans use preventive services at only about half the recommended rate.

The additional cost, whether due to high deductible plans or copayments or other cost-sharing requirements, discourages enrollees from seeking these preventive services, the government said.

Under the new rules, in order to be required, there must have a “strong scientific evidence” that a preventive service has a true health benefit.

Here is a summary provided by HHS of some of the services that will be covered under the new rules:

Evidence-based preventive services:

The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits.

Preventive services with a “grade” of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

Routine vaccines:

Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices ranging from routine childhood immunizations to periodic tetanus shots for adults.

Prevention for children:

Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics.

These guidelines provide pediatricians and other health care professionals with recommendations on the services they should provide to children from birth to age 21 to keep them healthy and improve their chances of becoming healthy adults.

The types of services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

Prevention for women:

Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by August 1, 2011.

To learn more:

• Visit Healthcare.gov, which has details about this and other provisions of the new healthcare reform law.
• Read a more detailed list of the covered services below. ↓

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Covered Preventive Services for Adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening for adults
• Type 2 Diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella
• Obesity screening and counseling for all adults
• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
• Tobacco Use screening for all adults and cessation interventions for tobacco users
• Syphilis screening for all adults at higher risk

Covered Preventive Services for Women, Including Pregnant Women

• Anemia screening on a routine basis for pregnant women
• Bacteriuria urinary tract or other infection screening for pregnant women
• BRCA counseling about genetic testing for women at higher risk
• Breast Cancer Mammography screenings every 1 to 2 years for women over 40
• Breast Cancer Chemoprevention counseling for women at higher risk
• Breast Feeding interventions to support and promote breast feeding
• Cervical Cancer screening for sexually active women
• Chlamydia Infection screening for younger women and other women at higher risk
• Folic Acid supplements for women who may become pregnant
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Osteoporosis screening for women over age 60 depending on risk factors
• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
• Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
• Syphilis screening for all pregnant women or other women at increased risk

Covered Preventive Services for Children

• Alcohol and Drug Use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Cervical Dysplasia screening for sexually active females
• Congenital Hypothyroidism screening for newborns
• Developmental screening for children under age 3, and surveillance throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
• Fluoride Chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, Weight and Body Mass Index measurements for children
• Hematocrit or Hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenzae type b
  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus
  • Inactivated Poliovirus
  • Influenza
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Medical History for all children throughout development
• Obesity screening and counseling
• Oral Health risk assessment for young children
• Phenylketonuria (PKU) screening for this genetic disorder in newborns
• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis
• Vision screening for all children

Tags: Health Insurance, Healthcare Reform, Insurance, Prevention

Category: Health Insurance, Healthcare Reform, News, Prevention