Under the Affordable Care Act (ACA), private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on members receiving these services.
The required preventive services are based on recommendations made by four medical and scientific bodies: the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project, and the Institute of Medicine (IOM) committee on women’s clinical preventive services.
New or updated recommendations issued by these expert panels generally must be covered without cost-sharing beginning in the plan year that starts on or after one year from the latest issue date. HMAA reviews these resources annually in August and makes benefit plan updates effective the following January 1, unless earlier implementation is needed due to a significant safety concern. The references provided reflect information published as of the month of August.