Health reform at 6 months: Free checkups and tetanus shots, anyone?

National health reform turns six months old on Sept. 23, when a variety of new rules and regulations take effect. In this weeklong series, we highlight how benefits will change for consumers in the near term. You can also find videos, news alerts, RSS feeds and other information at our health reform website.

Health insurers will be required to cover a host of preventive services and immunizations with no cost sharing for members under a requirement of national health reform soon to take effect. Cost sharing is when health plans – or employers offering health plans – require members to cover some costs associated with their coverage, such as co-payments for doctors’ office visits or for medications.

The requirements apply to preventive services, such as annual checkups, vaccinations and children’s wellness visits starting with plan years beginning on or after Sept. 23, 2010. Blue Cross Blue Shield of Michigan and Blue Care Network are covering the specified services with no cost sharing for services received by providers that participate in our network.

Blue Cross Blue Shield of Michigan and Blue Care Network already provided many of these services with little or no cost sharing prior to passage of health reform but are working to implement the new rules for all group and individual plans. For most Blues members, the rules take effect with plans that begin Jan. 1, 2011.

Various panels of experts and advisory committees have determined the list of evidence-based preventive services and immunizations that must be covered with no cost-sharing. They include:

  • Certain screenings for cancer
  • Diabetes preventive services
  • Counseling for smoking cessation
  • Routine childhood immunizations
  • Periodic tetanus shots for adults
  • Preventive care for children up to age 21, including:
  • Regular pediatric visits
  • Vision and hearing screening
  • Developmental assessments
  • Counseling to address obesity
  • Certain immunizations and preventive screenings

The federal government is currently developing its list of preventive services and screenings provided to women and expects to issue guidance by Aug. 1, 2011.

When preventive services are added by the panels of experts and advisory committees, health plans will be required to cover the services for plan years that start one year after the date of the new recommendation.

However, certain cost sharing may be charged to members, depending upon how a provider bills for services. Check out our related health reform alert for more information. While you’re there, be sure to subscribe to receive reform alerts via e-mail or RSS directly from the Blues.

You can view the full regulations at the U.S. Health and Human Services health care reform website.

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