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Women's preventive care has a caveat

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Photo/Thinkstock
Photo/Thinkstock

On Aug. 1, the government announced that the Affordable Care Act's provisions for free preventive women's health services had come into effect.

Now it's time for companies to be just as straightforward in telling their employees when those services will actually be free for them.

According to the U.S. Department of Health and Human Services, there are three complicating issues: health insurance policy renewal date, grandfathering and religious employers.

The first of those, renewal, is the simplest. Health insurers are required to provide the free services only for policies that begin or renew on or after Aug. 1. That means if your policy renewed before August, your provider is not required to offer the free services until the plan renews again.

Grandfathered plans are one exception to the rule. As defined on www.healthcare.gov, these are individual or job-based plans that existed on March 23, 2010, have covered at least one person continuously since then and are not subject to the requirements to add any free preventive services they weren't already providing.

Grandfathered policies may make routine changes without losing their status, including cost adjustments to keep pace with medical inflation, adding new benefits, making modest adjustments to existing benefits, voluntarily adopting new consumer protections under the new law or making changes to comply with state or federal laws.

A job-based grandfathered plan can even switch plan administrators or buy from a different insurance company as long as it does not make any prohibited changes to its cost or benefits structure.

However, if grandfathered plans do any of the following, they lose their status and are required to follow all strictures of the health care reform bill:

• Significantly cut or reduce benefits

• Raise co-insurance charges

• Significantly raise co-payment charges

• Significantly raise deductibles

• Significantly lower employer contributions

• Add or tighten an annual limit on what the insurer pays

The details of what constitutes "significantly" are technical and different for each point. For specifics, visit www.healthaffairs.org, go to the briefs section and search for "Grandfathered Health Plans."

The second exception to the rule is only partial: Qualifying religious employers are exempt from the requirement to cover contraceptive services. As defined by HHS, a religious employer is one that has the inculcation of religious values as its purpose; primarily employs persons who share its religious tenets; primarily serves persons who share its religious tenets; and is a nonprofit under specific IRS codes.

HHS estimates that when the provision is fully implemented, 47 million American women — including more than 2 million Pennsylvanians — will have access to the free services.

The Institute of Medicine of the National Academies recommended the services that the ACA included in the provision. A report on the institute's website says, "The inclusion of evidence-based screenings, counseling and procedures that address women's greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole."

What the new provisions cover

The women's preventive health services that insurance companies must offer without co-pay under the provisions of the Affordable Care Act are as follows:

• Well-woman visits

• Screening for gestational diabetes

• Human papillomavirus testing

• Counseling for sexually transmitted infections

• Counseling and screening for HIV

• Contraceptive methods and counseling

• Breastfeeding support, supplies and counseling

• Screening and counseling for interpersonal and domestic violence

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

Heather Stauffer

Heather Stauffer

Heather Stauffer covers Lancaster County, nonprofits, education and health care. Have a tip or question for her? Email her at heathers@cpbj.com. Follow her on Twitter, @StaufferCPBJ.

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