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Preventive services for women further defined

added Aug. 25, 2011

On Aug. 1, 2011, the U.S. Department of Health and Human Services adopted additional Guidelines for Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception and domestic violence screening – that will be covered without cost sharing (deductible, copays or co-insurance) in non-grandfathered health plans with plan years beginning on or after Aug. 1, 2012. The guidelines were recommended by the independent Institute of Medicine (IOM).

The additional preventive services for women that will be covered without cost sharing by non-grandfathered health plans include:

• Well-woman visits. This would include 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. This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes.
• HPV DNA testing. Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of pap smear results.
• STI counseling, and HIV screening and counseling. Sexually-active women will have access to annual counseling on HIV and sexually transmitted infections (STIs).
• Contraception and contraceptive counseling. Women will have access to all Food and Drug Administration-approved contraceptive methods as prescribed by their doctor, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. In addition, the guidelines also exempt certain religious employers from covering contraceptive services.
• 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. Screening and counseling for interpersonal and domestic violence is provided for all women.

For more details, please visit: www.hrsa.gov/womensguidelines.

The rules governing coverage of preventive services that allow health plans to use reasonable medical management to help define the nature of the covered service also apply to these women’s preventive services. Health plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.

For more details, see the information in our FAQs section.