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  • Preventive Services Covered under the Affordable Care Act

    If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider. 

    Covered Preventive Services for Adults

    • Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
    • Alcohol Misuse screening and counseling
    • Aspirin use for men and women of certain ages
    • Blood Pressure screening for all adults
    • Cholesterol screening for adults of certain ages or at higher risk
    • Colorectal Cancer screening for adults over 50
    • Depression screening for adults
    • Type 2 Diabetes screening for adults with high blood pressure
    • Diet counseling for adults at higher risk for chronic disease
    • HIV screening for all adults at higher risk
    • Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
      • Hepatitis A
      • Hepatitis B
      • Herpes Zoster
      • Human Papillomavirus
      • Influenza
      • Measles, Mumps, Rubella
      • Meningococcal
      • Pneumococcal
      • Tetanus, Diphtheria, Pertussis
      • Varicella
    • Obesity screening and counseling for all adults
    • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
    • Tobacco Use screening for all adults and cessation interventions for tobacco users
    • Syphilis screening for all adults at higher risk

    Covered Preventive Services for Women, Including Pregnant Women

    • Anemia screening on a routine basis for pregnant women
    • Bacteriuria urinary tract or other infection screening for pregnant women
    • BRCA counseling about genetic testing for women at higher risk
    • Breast Cancer Mammography screenings every 1 to 2 years for women over 40
    • Breast Cancer Chemoprevention counseling for women at higher risk
    • Breast Feeding interventions to support and promote breast feeding
    • Cervical Cancer screening for sexually active women
    • Chlamydia Infection screening for younger women and other women at higher risk
    • Folic Acid supplements for women who may become pregnant
    • Gonorrhea screening for all women at higher risk
    • Hepatitis B screening for pregnant women at their first prenatal visit
    • Osteoporosis screening for women over age 60 depending on risk factors
    • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
    • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
    • Syphilis screening for all pregnant women or other women at increased risk

    Covered Preventive Services for Children

    • Alcohol and Drug Use assessments for adolescents
    • Autism screening for children at 18 and 24 months
    • Behavioral assessments for children of all ages
    • Blood Pressure screening for children
    • Cervical Dysplasia screening for sexually active females
    • Congenital Hypothyroidism screening for newborns
    • Depression screening for adolescents at higher risk
    • Developmental screening for children under age 3, and surveillance throughout childhood
    • Dyslipidemia screening for children at higher risk of lipid disorders
    • Fluoride Chemoprevention supplements for children without fluoride in their water source
    • Gonorrhea preventive medication for the eyes of all newborns
    • Hearing screening for all newborns
    • Height, Weight and Body Mass Index measurements for children
    • Hematocrit or Hemoglobin screening for children
    • Hemoglobinopathies or sickle cell screening for newborns
    • HIV screening for adolescents at higher risk
    • Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
      • Diphtheria, Tetanus, Pertussis
      • Haemophilus influenzae type b
      • Hepatitis A
      • Hepatitis B
      • Human Papillomavirus
      • Inactivated Poliovirus
      • Influenza
      • Measles, Mumps, Rubella
      • Meningococcal
      • Pneumococcal
      • Rotavirus
      • Varicella
    • Iron supplements for children ages 6 to 12 months at risk for anemia
    • Lead screening for children at risk of exposure
    • Medical History for all children throughout development
    • Obesity screening and counseling
    • Oral Health risk assessment for young children
    • Phenylketonuria (PKU) screening for this genetic disorder in newborns
    • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
    • Tuberculin testing for children at higher risk of tuberculosis
    • Vision screening for all children

    While it’s easy to simply say that preventive care is covered at 100%, the actual administration of this benefit is exceedingly complex. Here are some common concerns and things you can do now to address them:

    * Eligible expenses. Some items on the list of covered services are not currently covered under most medical plans, such as aspirin, fluoride and iron supplements.   We recommend providing the list of covered items to your insurer early and ask them about their plan to address these types of items. If they do not yet have a plan of action, request semi-annual updates on the status.

    * Participant confusion. Finding a clear definition of the difference between preventive and routine care, and educating your participants, is also key.  Many services that a participant considers preventive are not, such as screening for skin cancer, follow-up care and colon cancer screenings for individuals under age 50.  We recommend requesting a list from your insurance company of the items considered preventive care and make this easily available internally to assist with minimizing confusion.

    As a precaution, we recommend contacting either your carrier or insurance broker to determine how any of the above items will be covered by your insurance carrier.

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