HHS, the Labor Department and the IRS released today the interim final rule implementing the Affordable Care Act’s preventive care mandate. Here is a link to the list of preventive care services that non-grandfathered plans must cover under this mandate with no-cost sharing when received from an in-network provider.
There is no obligation on health plans to provide these services out of network. Business Insurance explains that
The regulations * * * make clear that regular cost-sharing requirements can be imposed on an office visit when a recommended preventive service is billed as a separate charge.
In addition, treatment resulting from a preventive service can be subject to cost-sharing requirements if the treatment is not itself a recommended preventive service.
Regulators estimate that the new requirements will increase group health care plans’ costs by an average of 1.5% a year.
Mike Thompson, a principal with PricewaterhouseCoopers L.L.P. in New York said, though, the cost impact will be much lower for employers that already provide coverage for many preventive services.
As mentioned yesterday, the FEHB plan already offers generous in-network preventive services coverage.