Preventive Care Guidelines for Women

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Non-grandfathered health plans will need to include these services without cost-sharing for plan years beginning on or after Aug. 1, 2012 (Jan. 1, 2013, for calendar year plans), subject to the exception described below for religious employers.

Covered Health Services

The new preventive care guidelines for women cover the following health services:

Well-woman visits – Includes an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their providers determine they are necessary.

Gestational diabetes screening – Screening for women 24-28 weeks pregnant, and those at high risk of developing gestational diabetes.

Human papillomavirus (HPV) DNA testing for women age 30 and older – Women who are age 30 or older will have access to high-risk HPV DNA testing every three years, regardless of Pap smear results.

Sexually transmitted infection (STI) counseling – Sexually active women will have access to annual counseling on STIs.

Human immunodeficiency virus (HIV) screening and counseling – Sexually active women will have access to annual screening and counseling on HIV infections.

FDA-approved contraception methods and contraceptive counseling – Women will have access to all FDA-approved contraceptive methods, sterilization procedures and patient education and counseling.  **Keep in mind that in regards to contraception….. the carriers are only covering their “Tier 1” or “generic” contraceptives at $0-they can still charge a copay or cost-share if the rx is brand/non-preferred.  

Breastfeeding support, supplies and counseling – Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment.

Domestic violence screening and counseling – Screening and counseling for interpersonal and domestic violence.

According to HHS, health plans may use reasonable medical management techniques for women’s preventive care to help define the nature of the covered service, consistent with guidance provided in the interim final rules. For example, health plans may control costs and promote efficient delivery of care by continuing to charge cost-sharing for brand-name drugs if a safe and effective generic version is available. In addition, the interim final rules confirmed that plans may continue to impose cost-sharing requirements on preventive services that employees receive from out-of-network providers.

Effective dates for NJ carriers:

Aetna- When plans renew or are effective on or after 8/1/12.  For more information on Aetna, click here.

Amerihealth- For all fully-insured customers, this update will be effective 8/1/12.  For self-funded customers, this update will be on the group’s first renewal on or after 8/1/12.  For more information on Amerihealth, click here.

Cigna- When plans renew or are effective on or after 8/1/12.

Horizon- For small employer groups (2 to 50 employees) and groups of 51 to 99, this update will be effective 1/1/13.  For self-funded customers, this update will be on the group’s first renewal on or after 8/1/12. For more information on Horizon, click here.

Oxford- For all fully-insured customers, this update will be effective 8/1/12.  For self-funded customers, this update will be on the group’s first renewal on or after 8/1/12. For more information on Oxford, click here.

 

 

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