On January 9, 2014, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury (IRS) issued clarification on several outstanding issues within PPACA through an FAQ. Here is what is new for preventive care:
Preventive Care
The requirement that non-grandfathered plans provide first dollar coverage at 100% includes a provision to update the list of services that must be covered. The FAQ announces that because the United States Preventive Services Task Force (USPSTF) now recommends that breast cancer risk-reducing medications, such as tamoxifen or raloxifene, be prescribed for women who are at increased risk for breast cancer and are at low-risk for adverse medication effects, those medications (which can be expensive) must be covered at 100% beginning with the first plan year that starts on or after September 24, 2014, (starting January 1, 2015, for calendar year plans).
The FAQ also clarifies that a plan may use reasonable limits on the frequency (but not the dollar amount) of preventive care that it will cover. If the USPSTF recommendations include a frequency, those guidelines should be followed. If there is no guideline, the insurer or health plan may impose a reasonable frequency limit.
If you would like the Frequently Asked Questions – Part XVIII White Paper on all of the new clarifications, please Contact Us!
