New health care rules mandate 'free' preventive care
New policies will eliminate co-pays or deductibles for some services.
Starting Sept. 23, a range of preventive health care procedures, including colonoscopies and mammograms, must be provided to consumers at no out-of-pocket expense under any new health insurance policy.
The White House said Wednesday that under the health care law passed earlier this year, insurance companies must cover preventive services without the policyholder paying a deductible or co-payment.
The Obama administration said the rules will help Americans gain easier access to services such as blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children.
"Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs," said Health and Human Services Secretary Kathleen Sebelius.
The cost of covering these additional services will likely be passed on to consumers at some point through higher insurance premiums. However, health groups and even the insurance industry welcomed the new regulations, saying they were within the scope of the legislation and should promote better health.
The administration said chronic diseases, such as heart disease, cancer, and diabetes, are responsible for seven of 10 deaths each year and account for 75% of the nation's health spending -- and often are preventable. Nationally, consumers use preventive services at about half the recommended rate.
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Under the regulations, new health plans beginning on or after Sept. 23 and existing plans that undergo major revisions after Sept. 23 must cover preventive services that have strong scientific evidence of their health benefits, and these plans may no longer charge a patient a co-payment, co-insurance or deductible for these services when they are delivered by a network provider.
The services include:
- Evidence-based preventive services. The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a grade of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco-cessation counseling will be covered under the rules.
- Routine vaccines. Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, ranging from routine childhood immunizations to periodic tetanus shots for adults.
- Prevention for children. Health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. The services that will be covered include regular pediatrician visits, vision and hearing screening, developmental assessments, and screening and counseling to address obesity and help children maintain a healthy weight.
- Prevention for women. Health plans will cover preventive care provided to women under both the task force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, which are expected to be issued by Aug. 1, 2011.
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