As of September 23, 2010, new and non-grandfathered individual and group health plans must cover in-network preventive services and immunizations without cost sharing (e.g., deductibles, coinsurance, copayments) or annual limits.
Preventive care services and immunizations include:
- Recommended evidence-based preventive services from the United States Preventive Services Task Force with a rating of A or B
- Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
- Preventive care guidelines developed by the Health Resources and Services Administration and the American Academy of Pediatrics
- Effective August 1, 2012: expanded list of women’s preventive services, including well-woman visits, support for breastfeeding equipment, contraception and domestic violence screening
Read the most recent Preventive Services guidance:
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ESSENTIAL HEALTH BENEFITS
These new standards are required for individual and small group plans and may also affect large group plans.
EMPLOYER MANDATE IN REFORM
Businesses must offer affordable medical insurance that provides “minimum value” to employees and their dependents.
INDIVIDUAL MANDATE IN REFORM
Under the health care reform law, all people must have minimum essential coverage beginning January 1, 2014.