February 2012
January 29, 2012

Health care reform provides incentive to stay healthy

Author: Susan Klug
Source: NYSUT United

The Affordable Care Act of 2010 requires most health benefit plans renewing in 2011 to cover in-network preventive services with no patient cost sharing (deductible, co-pays, etc.). The covered services must be recommended by the U.S. Preventive Services Task Force or similar group. Some of the preventive services include routine immunizations, annual physical exams for adults and children and preventive services for women. The coverage also applies to evidenced-based screenings for conditions such as diabetes, cholesterol, obesity, HIV and sexually transmitted infections, various cancers and depression. Counseling for drug and tobacco use, healthy eating and other common health concerns is also covered. If the frequency or setting is not specified in the guidelines, the health plan can use reasonable judgment based on established medical practices.

This provision applies to both insured and self-insured health plans that are new or are "non-grandfathered" (had significant changes since March 23, 2010).

Retiree-only plans are not covered by this provision; however, Medicare has now included most of these same benefits under its coverage.