New Women's Preventive Services

Recently it was announced that the Affordable Care Act has been expanded to include additional prevention coverage for women's health and well being. Under the act, originally signed into law in March 2010, it is required that health plans cover preventive services without cost share, such as copays or coinsurance, when going to an in network provider. Coverage included preventive services like mammograms, colonoscopies, and immunizations.

On August 1, 2011, the Affordable Care Act was expanded to include well-woman visits, screening for gestational daibetes, HPV testing, counseling for STIs, counseling and screening for HIV, contraceptive methods and counseling (except when group exclusions apply), breast feeding support/counseling and supplies, and screening and counseling for interpersonal and domestic violence. For an outline of the guidelines, check out the US Department of Health and Human Services site.

Please note that these guideline are effective August 1, 2011, but non-grandfathered plan and issuers are not required to provider coverage without cost sharing consistent with the guidelines of the act until the first plan year that begins on or after August 1, 2012. As always, it is beneficial to contact your member services line with your insurance carrier to verify what all is covered (and how it will pay!) under your benefit plan.

Trends in Benefits: HPV Testing Not Covered as Preventive

Healthcare reform has brought on many changes to the healthcare industry, and one of the benefits that has brought about significant confusion has been the coverage of preventive services in full.

Recently, our team has begun to see a trend of charges for women going for their annual exam with their OB/GYN. Upon investigation, everything has been coded as preventive for many of these exams, but the charges are coming from the lab. Though most of the labs run are coded and can be run through benefits as preventive, HPV screenings are not on the approved list for preventive coverage and are therefore not covered in full. Thus, members are finding that their exams, which they believed would be covered in full, are having some charges. We have seen this happen with multiple carriers, especially as physcians are beginning to make this screening a part of their protocol for annual exams.

So long as this screening remains off of the list of codes that must be covered in full for preventive services and physicians continue to make this a part of their protocol, members will most likely continue to see this charge during their annual exam.

UPDATE: Please see our article on new women's preventative services

What should you do if your deductible, EOB, etc. does not match up with your HSA?

HSA accounts can be a great way to plan and pay for your medical expenses throughout the year. By offering you a tax-free option to pay for medical bills, prescriptions, and other qualifying expenses, you can get more out of your health care money.

Some individuals set up their plans so that they can cover the cost of their deductible with their HSA money. However, when their EOB and HSA balance do not match up or they run out of money before they meet their deductible, they are upset and confused. If you come across this situation, you will want to:

Resources for Staying Up-to-date on Reform

Staying up-to-date with the latest health care reform is not only important for groups, but it is also important for individuals. Knowing what is in the Afforadable Care Act and how it applies to you or your groups policy can make a large impact on how you utilize your benefits.

One of my favorite sites for group is the McGohan Brabender Health Care Reform site. Not only does is provide clarifications of many changes to health care, but it does so in an easy to understand format. If you are your group's plan adminstrator, I strongly suggest that you take a moment to peruse this site.

Additionally, I have found that Health Care and You is a nice site for both employers and employees. Here you can find state and age specific changes to laws as well as a handy timeline as changes have become effective.

It may seem as though there is a lot to know when it comes to keeping up-to-date on health care reform, but utilizing helpful resources such as these sites can ensure that your group - and employees - stay informed.

Aetna Pharmacy to No Longer Cover Allegra

Recently, the Food and Drug Administration approved Allegra as an Over-The-Counter medication. With this change, prescription Allegra , Allegra-D, and generic equivalents will no longer be covered under most Aetna Pharmacy benefits. As of March 4, 2011, these medications will be available over-the-counter.

Aetna members who filled a prescription for any of these medications or their generic equivalent between January 2010 and February 2011 will receive a letter from Aetna explaining this change as the medications will not longer be covered by Aetna's Pharmacy Benefits. Aetna's Preferred Drug List is subject to change. For up-to-date information, you can visit www.aetna.com/formulary or call the Member Services on the toll-free number found on your Member ID card.

Understanding Preventive Care Coverage

One of the changes to Healthcare over the past year included the coverage of recommended preventive services without charging out of pocket costs through the Affordable Care Act. With this change, many Americans have gone to the doctor for covered screenings including eye chart vision screenings, mammograms, and colonoscopies. However, confusion arises if they receive a bill for these screenings.

It is important as significant changes are made to fully understand what specifically is covered by your health plan. For instance, you may want to be aware of the following regarding Preventive Care Covered Services: