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Affordable Care Act Preventive Services Update

The United States Preventive Services Task Force (USPSTF) recently announced changes scheduled to go into effect in 2015. These updates will impact fully insured and self-insured non-grandfathered accounts, as well as grandfathered accounts that adopted Affordable Care Act preventive services benefits.

How are we implementing these changes?
To make the necessary changes and comply with these requirements, we are changing affected health plans to provide in-network coverage, without copayments, co-insurance, or deductibles for the affected preventive services. Coverage for these recommended services is subject to the individual health plan's network requirements and provisions.

Because the effective dates vary, we have streamlined the implementation approach to gain administrative efficiencies.

The table below provides a description of the services being affected and the effective dates.

Service USPSTF-Mandated Effective Date Blue Cross Implementation Approach
Dental carries prevention
  • Application of fluoride varnish to the primary teeth of all infants and children, by primary care clinicians in primary care practices
  • Applies to children starting at the age of primary tooth eruption through age 5
  • No limit on the number of applications per year
This does not apply to services by a dental health care provider.
Plan years beginning on or after 5/31/15 Effective 1/1/15 as a one-day change
Low-dose aspirin for pregnant women
  • Over-the-counter low-dose aspirin (81 mg/d) for pregnant women who are at high risk for preeclampsia
  • Must have a prescription from a licensed clinician
Plan years beginning on or after 9/30/15 Will be applied effective 10/1/15 as a one-day change

Have questions?
If you have any questions, please contact your account executive.

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