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Health care reform – women’s preventive care services

The most recent recommendations have been released by the Department of Health and Human Services (HHS) for women’s preventive care services. They will become effective for non-grandfathered Cigna plans on renewal dates occurring on or after August 1, 2012. We have listed the additional preventive care services for women that will be covered with no patient cost sharing:

  • Annual well-woman visits
  • Gestational diabetes screening
  • Human papillomavirus (HPV) DNA testing with Pap test for women 30 years and older
  • Sexually-transmitted infection counseling
  • Human immunodeficiency (HIV) screening and counseling
  • Domestic and interpersonal violence screening
  • Breast-feeding support, counseling, and supplies1
  • Contraception education and counseling, and Federal Drug Administration (FDA) approved contraception methods including birth control and sterilization for women2

Benefit plan exemptions

Some benefit plans may be exempt from providing coverage of contraceptive services due to their affiliation with a religious employer. You have several options to determine if your patient’s Cigna-administered plan covers these additional women’s preventive care services at 100 percent:

  • Use electronic data interchange (EDI) eligibility and benefit inquiry and response.
  • Visit the Cigna for Health Care Professionals website3 (CignaforHCP.com) to verify benefit and eligibility information for patients with a Cigna ID card.
  • Call Cigna at 1.800.88Cigna (1.800.882.4462). For patients with a GWH-Cigna ID card, call 1.866.494.2111.

Preventive health coverage guide available

Visit CignaforHCP.com for patient benefit and eligibility information, or call 1.800.88Cigna (882.4462). For additional information on preventive care, including A Guide to Cigna’s Preventive Health Coverage for Health Care Professionals, visit the Care Guidelines page on Cigna.com (Cigna.com > Health Care Professionals > Resources for Health Care Professionals > Health & Wellness Programs > Care Guidelines).

For additional details about the new women’s preventive care provision or other provisions, view our Informed On Reform page on Cigna.com (Cigna.com > Health Care Professionals > Informed on Reform.)

 

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1Provision of breast-feeding equipment and supplies will require a prescription and must be ordered through CareCentrix, Cigna’s national durable medical equipment vendor in order for the service to be covered. Precertification is required for certain types of breast pump equipment (e.g., hospital-grade electric breast pump).

2Subject to the patient’s pharmacy benefit, coverage of certain FDA-approved contraceptive products and services for women include oral contraceptives, diaphragms, some types of intrauterine devices (IUDs), vaginal ring, hormonal injections, contraceptive supplies (spermacide, female condoms), and emergency contraception. Cost sharing may be applied for brand-name products where generic alternatives are available. A prescription will be required for these medications and products, including over-the-counter medications and products, to be covered under the pharmacy benefit. Additional contraceptive services covered under the medical benefit include some types of IUDs, implants, and sterilization procedures for women.

3Information not available on CignaforHCP.com until the fourth quarter of 2012.

 
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THN-2012-298