Interim Final Regs Released Regarding Required Preventive Health Services
Interim final regulations were released on July 14, 2010, regarding preventive health services under the provisions of the health care reform laws. The final interim regulations require private health plans to cover certain preventive services and to eliminate cost-sharing from preventive care. For new health policies beginning on or after September 23, 2010, preventive services that have strong scientific evidence of their health benefits must be covered, and plans can no longer charge a patient a copayment, co-insurance or deductible for these services when they are delivered by a network provider. These rules do not apply to grandfathered plans. Required services include:
- Evidence-based preventive services, as recommended by the U.S. Preventive Services Task Force
- Routine vaccines, as recommended by the Advisory Committee on Immunization Practices (ACIP)
- Prevention for children, including regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight. Guidelines for these services are those supported by the Health Resources and Services Administration (HRSA).
- Prevention for women, as recommended by the U.S. Preventive Services Task Force and other medical professionals. These regulations are expected to be issued by August 1, 2011.
If a preventive service is provided during an office visit, but the recommended preventive service is billed separately (or tracked as individual encounter data separately), cost-sharing may be imposed for the office visit. Also, if a preventive service is provided during an office visit, and the two are not billed or tracked separately, cost-sharing may be imposed for the office visit if the main purpose of the office visit was not for the preventive service.
The complete list of required covered preventive services (not including preventive care for women) can be found at www.healthcare.gov/center/regulations/prevention/recommendations.html.
Guidelines for preventive services are regularly updated to reflect new scientific and medical advances. As new services are approved, health plans will be required to cover them with no cost-sharing for plan years beginning one year later. If a recommendation or guideline for a recommended preventive service does not specify the frequency, method, treatment, or setting for the provision of that service, the plan or issuer may use reasonable management techniques to determine any coverage limitations.
New Model Notices for Dependent Coverage, Patient Protections and Lifetime Limits
New model notices have been issued by the DOL for three health care reform requirements effective for plan years beginning on or after September 23, 2010.
- Dependent Coverage for Children Under Age 26
The notice to extend dependent coverage to age 26 should be included in enrollment materials, provided it is prominent. While enrollment will be effective retroactively to the first day of the first plan year beginning on or after September 23, 2010, administration of retroactive enrollments can be avoided if the notice is provided at least 30 days in advance of the first day of the first plan year before this requirement takes effect.
http://www.dol.gov/ebsa/dependentsmodelnotice.doc
- Lifetime Limits
This notice, which may be provided to an employee on behalf of the employee's dependent, can be included with enrollment materials, provided the statement is prominent. Eligible individuals must be treated as special enrollees, meaning that they have the right to enroll in all of the benefit packages available to similarly situated individuals upon initial enrollment.
http://www.dol.gov/ebsa/lifetimelimitsmodelnotice.doc
- Patient Protection
This is expressly an SPD obligation and should be included in the Plan Document and whenever the plan or insurer provides a participant with an SPD or similar description of the plan or coverage.
http://www.dol.gov/ebsa/patientprotectionmodelnotice.doc
Gary Eastes of City of Knoxville Makes Business Insurance Magazine's Benefit Management Honor Roll
Gary Eastes, Risk and Benefits Manager for Cowan client City of Knoxville, was named to Business Insurance's 2010 Benefit Management Honor Roll and was featured in the June 28, 2010 issue of the magazine. Gary was instrumental in creating and implementing the City of Knoxville's health incentive program and continues to steadily refine the program each year. The program includes incentives for general healthy habits, chronic disease self-care and consumerism.
Gary is driven by his passion that the benefit plan can help people become healthier and make better decisions. While working to implement his program, Gary understood that health risk appraisals alone were not going to influence a population - many of whom placed diet, exercise, and disease management low on the priority list - to make substantial changes. He knew the strategy must incorporate benefit design; financial incentives or disincentives; strong, consistent communication; and face-to-face meetings with clinical staff.
The results of his efforts have been dramatic. The program has improved employee health and has even detected some potentially devastating health problems early. During the five years before this program was fully implemented in 2006, the City's health insurance premiums rose 141 percent. During the past three years, the City's insurance premiums have increased, on average, approximately six percent a year - a much lower rate than national averages, leading to significant taxpayer savings.
Cowan is proud to have been able to partner with Gary as he has worked so hard and has overcome great obstacles to see his vision become a reality.
www.cowanbenefit.com/files/Gary Eastes and Matt Cowan.jpg
