Preventive Care

Explanation

The ACA requires non-grandfathered plans to provide coverage for certain “preventive care”. This coverage must be provided without cost sharing (e.g., coinsurance, deductible or copayment) for services provided in network. All non-grandfathered group health plans (insured and self-funded) and non-grandfathered individual policies issued or renewed on or after September 23, 2010 must cover preventive services without cost share (e.g., coinsurance, deductible or co-payment).

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