Note: An earlier version of this article was published in the July 2012 edition of Partners in Health Update. The bolded text indicates new language that was not in the previous version of the article. On August 1, 2012, AmeriHealth expanded the list of women?s preventive health services that are covered at 100 percent (i.e., $0 copayment) for certain members. In response to the federal health care reform act known as the Patient Protection and Affordable Care Act of 2010, the Department of Health and Human Services (HHS) announced a modification to the August 2011 interim final rule, expanding the list of preventive services with a $0 copayment when performed in-network. As a result, AmeriHealth has updated commercial health plans to eliminate member cost-sharing for an expanded list of women?s preventive services for all non-grandfathered plans. The federal rule that took effect on August 1, 2012, impacted all non-grandfathered AmeriHealth medical and prescription drug plans. Please note the following groups are exempt from the federal ruling: groups that have maintained grandfathered status for their health benefit plans; all Medicare Supplement and Medicare Advantage plans; for contraceptive services only, groups that meet the definition of a religious employer or that are able to certify for a one-year temporary safe harbor.

Coverage for women?s preventive services

As a result of the 2011 HHS modification to the health care reform act, AmeriHealth currently provides 100 percent coverage (i.e., $0 copayment) to all commercial health plans for the following six preventive care services for women when they are performed in-network: well-woman visits counseling for sexually transmitted infections screening for gestational diabetes screening and counseling for HIV screening for human papillomavirus (HPV) screening and counseling for interpersonal and domestic violence As of August 1, 2012, AmeriHealth also provides 100 percent coverage for the following two additional preventive services: Contraception methods and counseling. All FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling will be available to women at a $0 copayment when performed in-network. Medical procedures such as contraceptive devices and injectable contraceptives will also be eligible for $0 copayment when performed in-network. All generic oral contraceptives will be covered at 100 percent at retail and mail-order pharmacies. Cost-sharing will continue to apply to brand and non-formulary prescription drugs; there is no change in current state for non-generic tiers. Breastfeeding support, supplies, and counseling. Women will have access to comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the postpartum period. Current coverage provides for lactation support received during an inpatient maternity stay as part of an inpatient admission or postpartum home care visits. Support is also available at the mother?s postpartum office visits and well-baby visits. The in-network cost-sharing will be removed. Breast pump rental and breastfeeding equipment are available to women without cost-sharing subject to approval for medical necessity. As always, continue to check the NaviNet^? web portal for member eligibility and copayment amounts. To do so, select Eligibility and Benefits Inquiry from the Plan Transactions menu, enter the search criteria for the member, and click Select next to the appropriate member. In the Copays section, select Preventive Services to view Medical Policy #00.06.02e: Preventive Care Services, which lists all preventive services that have a $0 copayment and are covered at 100 percent. If you are not NaviNet-enabled, visit the Medical Policy website. Select Accept and Go to Medical Policy Online and then type the policy name or number in the Search box.

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