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Changes to Women's Preventive Services Take Effect


  05:19:10 pm, by MedBen5   , 547 words,  
Categories: News, Wellness, Health Plan Management

Changes to Women's Preventive Services Take Effect

On August 1, 2011, the U.S. Department of Health and Human Services adopted women’s preventive health care services guidelines developed by the Institute of Medicine. The services listed in these guidelines are added to the required covered preventive services for non-grandfathered health plans under the Patient Protection and Affordable Care Act (PPACA). If your plan is non-grandfathered and self-funded, these must be covered at 100% beginning with the first plan year on or after August 1, 2012. If your plan is fully-insured through Medical Benefits Mutual, these services will be covered under your plan starting with your next renewal on or after August 1st.

What preventive services will be added?

  • Annual well woman exam: Including all services that are age and developmentally appropriate, such as pre-conception and pre-natal care. This could include the first prenatal visit, even for a dependent child. Additional visits may be required to provide all necessary services.
  • Gestational diabetes screenings: For all women, including dependent children, at twenty-four (24) to twenty-eight (28) weeks of gestation (or on the first pre-natal visit, if identified at high risk for diabetes).
  • HPV testing: Once every three (3) years, beginning at age thirty (30).
  • All Food and Drug Administration (FDA) approved contraceptive methods: These contraceptives could still be covered through a prescription drug card/mail order program. No copayment applies.

    Certain non-profit religious organizations may claim an exemption from this requirement if they have not previously covered contraceptives under their health plan. If you feel you may qualify for this exemption, contact MedBen for more information.

  • Elective sterilization procedures: Coverage is required for all females, including dependent children. Coverage is not required for covered males, though consideration for providing equal coverage for male employees and spouses is recommended, as such procedures performed on males are generally less costly.
  • Breast-feeding counseling and rental (but not purchase) of breast-feeding equipment: Coverage for all females, including dependent children.
  • Annual counseling regarding sexually transmitted diseases for all sexually active women.
  • Annual screening and counseling regarding domestic abuse.

What is MedBen asking you to do to make these required changes? If your plan is self-funded and non-grandfathered, MedBen will be sending you a Women’s Health PPACA Checklist prior to your next plan year and will ask you to review and complete the checklist. Contact your group service representative or Annette McNair in our Compliance Department if there is anything you don’t understand. If you are fully-insured, MedBen will take care of making the necessary changes to the certificate of coverage.

When does MedBen need to receive your response? MedBen will need self-funded plan changes in time to get any necessary approval from your stop-loss carrier, and we will need time to make necessary system changes and draft amendments for your signature. We would, therefore, recommend that you get the changes to us at least a month before your next plan year, if possible.

Once MedBen receives this information from you, what will MedBen do to assist with these changes? To assist with these changes MedBen will get stop-loss carrier approval (unless your agent handles that for you), make the necessary system changes and draft amendments for your signature, and provide a summary of material modifications to distribute to your employees.

For more information regarding these requirements, MedBen clients may contact Annette McNair, Director of Compliance, at (800) 423-3151, Ext. 410.

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