Starting September 23rd, many changes to group health plans are being made in all the states, if they renew by that date or after. The Patient Protection and Affordable Care Act, more commonly known as the Federal Health Care Reform , has made it possible for many prevention services and tests to be available and covered in full.
The list of prevention services and tests could change, depending on the “issuance of further guidance from the federal government pursuant to the Affordable Care Act.” Also, “for POS and PPO plans, services are covered in full at the in-network benefit level. Out-of-network cost sharing remains the same.”
Some of the prevention services and tests are as followed:
- Autism Screening (for children at 18 and 24 months of age; primary care settings)
- Blood pressure screening (Adults, without known hypertension)
- Breast cancer screening, including mammograms and counseling for genetic susceptibility
- Cervical cancer screening, including pap smears
- Cholesterol screening (for adults only)
- Dental caries prevention – oral fluoride (for children to age 5 only) [Note: Coverage for fluoride is only provided if your Plan includes outpatient pharmacy coverage.]
- Depression screening (Adults, Children ages 12-18, primary care visits only)
- Diabetes screenings
- Hearing Screening (Screening for newborn only, primary care settings)
- Hepatitis B testing
- HIV screening
- Immunizations , including flu shots (for children and adults as appropriate)
- Osteoporosis screening (screening to begin at age 60 for women at increased risk)
- Ovarian cancer susceptibility screening
- Sexually transmitted diseases (STDs) – screenings and counseling
This information refers to products and services offered by Harvard Pilgrim Health Care and its affiliates, Harvard Pilgrim Health Care of New England and HPHC Insurance Company.
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