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Health Care Reform Expands Preventive Care Coverage for Women - March 2012

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On August 1, 2011, the Department of Health and Human Services (HHS) released new guidelines outlining required preventive care services for women. The new guidelines require non-grandfathered health plans to cover these services without cost sharing for policies beginning on or after August 1, 2012. The chart below shares details of how each service will impact current benefits for Empire policies. It is important to remember that not all plans are subject to the new guidelines, and policies under the new guidelines have varied effective dates. Providers should continue to verify eligibility and benefits when determining copayments or coinsurance due by members for services rendered. 
 

Preventive Service Guideline Description of Requirement Current Benefits Future Benefit Under HCR (effective on or after 08/01/12)
Well Woman Visits 
Well woman preventive care visit to be covered annually at 100% for adult women to obtain the recommended preventive services that are age and developmentally appropriate. 
We currently cover preventive visits. 
No additional services will be added.  
Screening for Gestational Diabetes 
Screening for gestational diabetes to be covered at 100% under preventive benefits. 
We currently cover gestational diabetes screenings as a diagnostic service under maternity benefits. 
We will cover gestational diabetes screening for women at 100% under preventive benefits. 
HPV Testing 
High-risk human papillomavirus DNA testing in women with normal cytology results will be covered at 100% under preventive benefits.  
We currently cover cervical cancer screenings (pap smears) for sexually active women.  
We will cover HPV testing for all women.  
Counseling for Sexually Transmitted Infections 
Counseling on sexually transmitted infections (STIs) for all sexually active women will be covered at 100% under preventive benefits.  
We currently cover counseling for STIs.  
No additional services will be added.  
Counseling and Screening for HIV 
Counseling and screening for human immune-deficiency virus infection for all sexually active women at 100% under preventive benefits.  
We currently cover counseling and screening for HIV.  
No additional services will be added.  
Contraceptives and Counseling (females only) 
All Food & Drug Administration (FDA) approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity will be covered at 100% under preventive care. 
We currently cover women’s preventive visits and counseling under preventive benefits.  
We will add coverage for “medical” contraceptives/sterilizations (office or facility based medical and surgical services) to the preventive benefit for females. There will be no age or frequency limits.  
We will add coverage for pharmacy prescription contraceptives for females to the preventive benefit. This coverage will be available through retail pharmacies or mail order. We will cover generic oral contraceptives (birth control bills) at 100%, and those brands which do not have a generic equivalent. Multisource brands with a generic equivalent will continue to require a patient cost share. Over-the-counter contraceptives will not be covered.  
Since we currently cover preventive visits and counseling under the preventive benefit, no additional benefits will be added related to these services.  
Breastfeeding Support, Supplies, and Counseling  
Comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment covered at 100% under preventive benefits. 
We currently cover lactation classes, preventive visits and counseling services under the preventive benefit.  
We will add coverage for breast pumps (rental and purchase) and breast pump supplies to the preventive benefit. These services will be covered as medical (not pharmacy) benefits. Breast pumps must be purchased/rented from an in-network medical provider to get 100% coverage. Breast pumps obtained from other sources will be covered, but may result in a member cost share. One breast pump will be covered per pregnancy, although exceptions may be approved through the appeal/authorization process. 
Screening and Counseling for Interpersonal and Domestic Violence 
Screening and counseling for interpersonal and domestic violence covered at 100% under preventive benefits.  
We currently cover preventive visits and preventive counseling services under preventive benefits.  
No additional services will be added.  
 
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