Based on a recommendation from the Institute of Medicine (IOM), the U.S. Department of Health and Human Resources announced Aug. 1, 2011, that the following women’s preventive services must be provided with no cost-sharing (deductible, copays or coinsurance) for non-grandfathered health plans with plan years beginning on or after Aug. 1, 2012: well-woman visits; gestational diabetes screening; HPV DNA testing; STI counseling, and HIV screening and counseling; contraception and contraceptive counseling; breastfeeding support, supplies and counseling; and domestic violence screening. For more detailed information, please visit www.hrsa.gov/womensguidelines.
Are all health plans required to provide the women’s preventive services with no cost-sharing?
No, grandfathered plans are not required to offer any of the preventive services – those specifically for women’s health or the general listing for all persons – with no cost-sharing. All non-grandfathered plans must include the women’s preventive services and may not require their members to pay deductibles, copays or coinsurance for plan years beginning on or after Aug. 1, 2012. If an existing plan were to lose its grandfather status, then it must begin to include these preventive services with no cost-sharing.
My health plan is considered a grandfathered plan. Will I receive these women’s preventive services without out-of-pocket costs?
Grandfathered health plans are not required to offer any of the preventive services – either the general listing for all persons or the specific list for women – with no cost-sharing. Your employer or health plan may choose to add any of these preventive services with no cost-sharing to your benefits plan at your next plan anniversary, but they are not required to do so by law. If your existing plan were to lose its grandfather status, then it must begin to include these preventive services with no cost-sharing.
By including contraceptives in this listing, does that mean that I will be able to get my birth control pills for free?
The new guidelines require non-grandfathered health plans to provide all Food and Drug Administration-approved contraceptives as prescribed by your doctor, meaning that you could receive your prescription birth control pills with no cost-sharing. You should note, though, that your health plan is allowed the flexibility to control costs by, for example, requiring you to pay a copayment if you choose a brand-name drug when a generic drug is available, and is equally safe and effective.
My employer is a religious organization that opposes the use of artificial birth control methods and sterilization. Will my employer be required to provide this coverage?
No, religious employers for whom contraception is inconsistent with their tenets can choose to offer health insurance that does not cover contraception.
If one of the preventive services that I receive without cost-sharing provides a diagnosis for which I need additional treatment, is that recommended treatment also covered by the health plan without any cost to me?
No, only the screening or other preventive service specified by the federal government is provided with no cost to the plan member. When it comes to receiving recommended treatment services for any diagnosed condition, then any deductible, copay or coinsurance required by your benefits plan would apply to those services.
Are these preventive services provided at no cost to me regardless of whether I receive them in-network or out-of-network?
Health plans are only required to cover recommended preventive services received from an in-network provider; you may be required to pay deductibles, copay or coinsurance if you receive these services from a non-contracting provider.
These preventive services are sometimes referred to as “free” in media reports. Is this an accurate term to describe preventive services?
While preventive services as outlined by the health care reform law might be “free” to the consumer at the time they are received – meaning they pay no out-of-pocket costs at that time – consumers should understand that these services are not truly “free.” The cost to receive these services will be reflected in a consumer’s insurance premium.
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