Expanded Coverage for Preventive Care Under National Health Care Reform
The Patient Protection and Affordable Care Act (PPACA), also known as national health care reform, was signed into law on March 23, 2010. As part of the new law, beginning with plan years on or after September 23, 2010, group and individual health plans, as well as group health insurers, can no longer require cost sharing for certain preventive services. In addition, coverage must be provided for some preventive services. Such services may include screenings, immunizations, and other types of care, as recommended by the federal government.
On August 1, 2011 new guidance was released on Preventive Health Services for Women.
Effect the New Rules Will Have on Members and Accounts
Blue Cross Blue Shield of Massachusetts is committed to implementing these coverage changes in a way that best suits the needs and expectations of our members. As such, we will be removing member cost sharing and adding coverage for certain preventive services in our standard plans that currently apply a cost share or do not offer the required coverage.
These changes will apply to our insured and self–insured medical accounts, unless the account's plan has grandfathered status. In this case, the grandfathered plan is not required to make the changes upon renewal.
Blue Cross Blue Shield of Massachusetts will offer the following services with no member cost share when they are administered by network providers:1
Preventive Services with No Cost Sharing
Blue Cross Blue Shield of Massachusetts will cover the preventive services listed in the following charts at no cost to our members when they are provided by a network provider. Some of these services may also be covered as part of routine physical exams, such as checkups, routine gynecological visits, or well–child exams. Please note that the services listed here may not be considered preventive when they are received to diagnose or treat an illness or injury or billed by the provider as such.
Preventive Services with No Cost Share for Adults (Ages 19 and Older)
|Screenings and Tests||Counseling Services||Pharmacy Services2 and Immunizations3|
Preventive Services with No Cost Share for Children (Birth to 18 Years)
|Screenings, Tests, and Counseling Services||Pharmacy Services2||Immunizations3|
If you have questions regarding coverage for preventive services, please contact your account service representatives or call Member Service at the number on the front of your ID card.
1. The list of preventive care services and tests that will be covered with no member cost share is subject to change upon the issuance of further guidance from the federal government pursuant to PPACA. Blue Cross Blue Shield of Massachusetts has updated its products, and certain plan designs may have expanded preventive benefits beyond what is required by national health care reform. Some grandfathered and/or self–insured plan designs may have a more limited selection.
2. A licensed clinician must prescribe these medications; this does not apply to medications available over the counter.
3. Doses, recommended ages, and recommended populations vary.
This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.
Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.
For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.