Medical Insurance Blog

Anthem Blue Cross & Insurance Reform Relating to Preventative Care

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The new health care reform law includes a provision that requires medical insurance companies to provide preventative services without any member cost sharing. 

Non-grandfathered plans issued or renewed on or after September 23, 2010 will not include member cost sharing or copays for the following preventative care services provided in-network:

• Items or services that have an A or a B rating in the current recommendations of the United States Preventative Services Task Force.  You can see a list of these services at: http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm.
• Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.  You can see a list of these immunizations at: http://www.cdc.gov/vaccines/recs/acip/default.htm
• Evidence-informed preventative care and screenings provided for in comprehensive guidelines for infants, children and adolescents that are supported by the Health Resources and Services Administration.  You can view more information at: http://www.hrsa.gov/
• Evidence-informed preventative care and screenings for women not otherwise addressed by the U.S. Preventative Services Task Force recommendations that are supported by the Health Resources and Services Administration.

This impacts non-grandfathered plans issued or renewed on or after September 23, 2010, and it only applies to in-network services.  Out-of-network services will have the same cost-sharing requirements as they do today.

Most of the recommended screenings, immunizations and exam services are already on Anthem's preventative services list.  They are adding the new, required preventative services to this existing list.  One example of a new preventative service is counseling for aspirin use, tobacco cessation, obesity and alcohol use.  In addition, some services that are currently covered as a maternity benefit, such as recommended pregnancy screenings for pregnant women, will now be covered as a preventative service.