Under Section 2713 of 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 patients receiving these services.
The required preventive services come from 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 HRSA and the Institute of Medicine (IOM) committee on women’s clinical preventive services.
New or updated recommendations issued by these expert panels are required to be covered without cost-sharing beginning in the plan year that begins on or after exactly one year from the latest issue date. If a recommendation is changed during a plan year, an issuer is not required to make changes mid-plan year, unless one of the recommending bodies determines that a service is discouraged because it is harmful or poses a significant safety concern. HMAA reviews these resources annually in August and makes benefit plan updates effective the following January 1. The references provided reflect information published as of the month of August.