Preventive Care

Explanation

Coverage of specified preventive care is required of non-grandfathered plans without cost sharing (deductibles, copayments, coinsurance, etc.), when provided in network. Preventive care is defined as items or services with an A or B rating by the U.S. Preventive Services Task Force, immunizations recommended by the CDC, preventive care and screenings for infants, children and adolescents supported by HRSA, and screenings for women supported by HRSA. Other preventive services may be covered beyond what is included in the recommendations, and those services may be subject to cost sharing.[Section 2713 of H.R. 3590]

Aetna’s take and action

• Aetna has developed a list of covered preventive services, based on the recommended preventive services, and will cover them without cost sharing in all insured plans on renewal or effective date on or after Sept. 23, 2010 (except grandfathered plans). Any new recommendations adopted after the publication of the interim final regulation will be reviewed and incorporated for non-grandfathered insured plans within the required timeframe.
• We will provide our self-funded plan sponsors with this list of services but recommend that they seek the advice of their own counsel regarding compliance.
• We have provided account teams with information they can share with plan sponsors, including a member communication detailing the covered services.
• We are providing doctors in our networks with information to help make sure they know about our preventive care coverage.

Questions and answers

• Does ACA require coverage of preventive care? 
• What services are considered preventive care? 
• Do the requirements apply to both in-network and out-of-network services? 
• If preventive care is provided during an office visit, can cost-sharing requirements be imposed? 

View all Preventive Care Services Q&As