In addition to information governing cost-sharing limits addressed by new Affordable Care Act (ACA) regulations, the latest set of Frequently Asked Questions (FAQs) issued by the Department of Labor provides guidance on the health care law’s coverage of preventive services.
Changes to the Public Health Services (PHS) Act made by the ACA require non-grandfathered health plans and health insurance offered in the individual or group markets to provide certain services and benefits coverage without cost-sharing, including:
- Evidenced-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the U.S. Preventive Services Task Force (USPSTF) with respect to the individual involved;
- Immunizations for routine use in children, adolescents, and adults that have in effect an immunization recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC);
- With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and
- With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA, to the extent not already included in certain recommendations of the USPSTF.
The guidance clarifies a number of issues related to the above services and discusses what types of services within these categories must be covered without cost-sharing. For example, the FAQs explain that if a plan does not offer any in-network providers of these specific services, it cannot impose cost-sharing when they are provided by an out-of-network provider. Additionally, the guidance states that plans need to provide aspirin and other over-the-counter medications without cost-sharing only if they are prescribed by a health care provider.
The majority of the 20 FAQs answer questions related to women’s preventive services.
The previous 11 sets of FAQs on the ACA’s implementation can be found here.
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