The new services must be covered without cost-sharing by non-grandfathered health plans, regardless of whether they are insured or self-insured.
The following eight (8) categories of women’s services are now included on the list of mandatory preventive services:
1. well-woman visits
2. gestational diabetes screening
3. HPV DNA testing
4. sexually-transmitted infection counseling
5. HIV screening and counseling
6. FDA-approved contraception methods and contraceptive counseling
7. breastfeeding support, supplies and counseling
8. domestic violence screening and counseling
Non-grandfathered group health plans will need to provide these additional preventive services for plan years beginning on or after August 1, 2012. For calendar year plans, this means compliance is required beginning January 1, 2013.
There will be a cost impact for plans that do not currently cover these services and for plans that currently impose cost sharing on these services or supplies (e.g., contraceptives). In addition, plan documents and SPDs will need to be amended to reflect coverage of these new preventive items and services.
Public comments on this amendment to the preventive service interim final regulation are due October 3, 2011.
This is a summary of the guidance. A more detailed explanation can be found on the Towers Watson website.
Horizon Actuarial Services, LLC is an independent company and is not affiliated with Towers Watson.