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, IBC 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, IBC 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 IBC 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, IBC
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, IBC 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.
NaviNet? is a registered trademark of NaviNet,
Inc., an independent company.