Market News
Affordable Care Act Expands Preventive Services Coverage for Women
August 2, 2011
In the summer of 2010, HHS published new rules under the Affordable Care Act, requiring all new private health plans and all non-grandfathered health plans to cover evidence-based preventive services at no cost to the patient. At that same time, HHS announced that the law would require insurance companies to add additional preventive health benefits for women to ensure that a comprehensive set of preventive services would be available, again, at $0 cost to the patient.
On August 1, 2011, HHS adopted additional Guidelines for Women’s Preventive Services. While some health plans have been covering these services for women already, the new federal Guidelines guarantee that ALL private health plans will be administering these benefits equally, on the same schedule, with no out-of-pocket expense to the member. New health plans and non-grandfathered health plans will be required to include these services without cost sharing in the first plan year beginning on or after August 1, 2012.
An interim final rule was also just released to give religious organizations the choice as to whether they want to include coverage for contraception if this coverage is inconsistent with their tenets.
Additional Women’s Preventive Services that must be covered without cost sharing include:
- Well-woman visits: This would include an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their providers determine they are necessary. These visits will help women and their doctors determine what preventive services are appropriate, and set up a plan to help women get the care they need to be healthy.
- Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood.
- HPV DNA testing: Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of pap smear results. Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer.
- STI counseling, and HIV screening and counseling: Sexually-active women will have access to annual counseling on HIV and sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28% of women aged 18 to 44 years reported that they had discussed STIs with a doctor or nurse. In addition, women are at increased risk of contracting HIV/AIDS. From 1999 to 2003, the CDC reported a 15% increase in AIDS cases among women, and a 1% increase among men.
- Contraception and contraceptive counseling: Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. Most workers in employer-sponsored plans are currently covered for contraceptives. Family planning services are an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes.
- Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their children’s and their own health. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.
- Domestic violence screening: Screening and counseling for interpersonal and domestic violence should be provided for all women. An estimated 25% of women in theU.S. report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.
For more information please contact our Benefits Department at info@hendersonbrothers.com
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