BEST Life’s Non-Grandfathered Health Plans offer preventive services 100% coverage, whether those services are provided in-network or out-of-network. To better explain what exactly is covered by these plans, BEST Life had created new a educational flyer for our members. This Preventive Services flyer is available in the Member portal of the BEST Life website and is included in the Health Resource Center.
How are services determined to be preventive?
The Patient Protection and Affordable Care Act (“PPACA”) requires non-grandfathered plans to cover what the U.S. Preventive Services Task Force rates as an A or B Preventive Service. This provided the first list of preventive services. However, the U.S. Department of Human and Health Services (“HHS”) can also determine what preventive services should be covered, and these services can change at any time.
As recently as August 1, 2011, the HHS adopted new Guidelines for Women’s Preventive Services based on recommendations by the Institute of Medicine and new scientific evidence. Starting with new health plans effective August 1, 2012, additional services like support for renting breastfeeding equipment, contraception and domestic violence screening will be considered preventive and be covered at 100%.
Even though the new guidelines include woman’s wellness visits, our plans already cover these and pap smears at 100%.
BEST Life is currently evaluating how these new guidelines affect Non-Grandfathered plans and will implement them in August 2012.
Any changes to the Non-Grandfathered Plans will also include updates to the Preventive Services flyers. So you may want to check back with us for these updates.
How are Preventive Services covered?
Your doctor will recommend preventive services based on your age, gender, health, and risk for developing disease. Preventive services are covered at 100% as long as that is the main purpose of the visit. Services performed to diagnose a specific illness or injury you have at the time of the visit is not considered preventive and will not be covered. (Think of the difference between a routine annual physical versus an office visit to determine if you have allergies or a sinus infection.)
For this reason, we recommend that you do not combine sick visits with your wellness visit.
Your doctor will schedule a follow-up visit for any illnesses identified as a result of the preventive care you receive. These follow-up visits are covered under your plan as a regular office visit. In this case, a co-payment, deductible and coinsurance may apply. Please see your Certificate of Insurance for details.
If you have questions about how preventive services are covered on your plan, our Customer Service Department is available to help. They can be contacted Monday through Friday, 7 am to 5 pm PST at 1-800-433-0088 or via email at cs@bestlife.com.
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Filed under: Health, Health Care Reform, medical insurance Tagged: | HHS, New Guidelines, PPACA, Preventive Services
