Acting Pennsylvania Insurance Commissioner Teresa Miller Reminds Consumers of Preventive Care Benefits Covered Under Affordable Care Act

HARRISBURG, Pa., May 19, 2015 /PRNewswire-USNewswire/ -- Acting Insurance Commissioner Teresa Miller reminded consumers today that most health plans must cover various preventive care benefits at no cost to the consumer.

"Many health plans are required to provide preventive care services available at no extra cost to consumers," said Miller. "I want to ensure that Pennsylvanians know the benefits that are available to them through their health plan so that they may make good use of these services to protect themselves and their families."

Preventive care benefits are available for adults, women, and children who have non-grandfathered coverage through their employer or individual coverage purchased from a health insurance company, regardless of whether they bought through the federal marketplace or directly from a company. Grandfathered plans were created or initially purchased on or before March 23, 2010, and are exempted from many changes required under the Affordable Care Act. A health plan must disclose in its plan materials whether it is grandfathered.  According to the federal Department of Health and Human Services, roughly 137 million individuals in the United States have health insurance that provides access to preventive care. Applicable services are available at no cost to the consumer, regardless of your deductible, when obtained through an in-network provider.

The PA Department of Insurance is working with insurers to make certain that plans are compliant in their preventative care options so that consumers are aware and can take advantage of these benefits.

For adults, preventive care screenings are available to monitor for various cancers, blood pressure issues, Type 2 Diabetes, and immunization vaccines, including annual flu shots. Tobacco cessation and obesity screenings and counseling are also available without cost-sharing under the Affordable Care Act.

Earlier this month, the Department of Health and Human Services issued a notice reminding insurance providers that they must cover Food and Drug Administration-approved contraceptive methods. Under the Affordable Care Act, contraception is available without cost-sharing when obtained through an in-network provider. Women are advised to ensure that the specific brand they are prescribed is covered by their insurance provider, as providers only need to cover at least one type of each of the approved methods to be compliant. However, if a woman's health care provider recommends a specific FDA-approved contraceptive item or service because of medical necessity, the plan or issuer must cover that service or item. This mandate does not apply to certain exempt plans and employers eligible for a religious exemption. To read the recently-issued notice, go to http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf

Other preventive care services available to women include mammograms, chemoprevention counseling for women with a higher risk for breast cancer, and additional services for pregnant women included anemia and gestational diabetes screenings.

Children are also entitled to an array of preventive services, including immunization vaccines (including annual flu shots), autism and developmental screenings, fluoride supplements, and various tests for newborns, among others.

"Taking advantage of these benefits like health screenings and vaccines can keep you healthy and protect you from future health issues," said Miller.

For more information on preventive care benefits available under the Affordable Care Act, visit www.healthcare.gov/preventive-care-benefits/.

If you believe you are being incorrectly billed by your insurance provider for a service that should be without cost-sharing, or have a question about whether your plan is required to provide these benefits, you may call with the Insurance Department's Bureau of Consumer Services toll-free at 1-877-881-6388. You may also file a complaint online at www.insurance.pa.gov under the "Services for Consumers" tab.

MEDIA CONTACT: Alison Fogarty, 717-787-3289

SOURCE Pennsylvania Insurance Department

Related Links

http://www.insurance.pa.gov