Preventive Care Under The PPACA May Increase Your Health Care Costs

Posted by The ALS Group on Jun 11, 2013 12:51:13 PM


Under the Patient Protection and Affordable Care Act (PPACA) all non-grandfathered plans must offer their employees preventive health care without copays or deductibles. What is preventive care?

  • Those services that the U.S. Preventive Services Task Force gives an A or B rating.
  • Immunizations recommended by the Immunization Practices Advisory Committee of the Centers for Disease Control and Prevention.
  • Certain preventive care for babies, teenagers and adolescents supported by the Health Resources and Services Administration.
  • Preventive care and screenings for females recommended by the Health Resources and Services Administration recommends.

Because the requirements of the ACA generated many questions from employers, the federal government issued a recent update that outlines the following:

  • Employers must offer out-of-network preventive care at no additional cost to employees if no in-network providers offer these services.
  • Employers must offer routine immunizations without cost-sharing in the plan year that begins one year after the Centers for Disease Control (CDC) begins recommending that immunization.
  • If a screening or immunization applies only to “high-risk” employees, the attendant healthcare provider determines if that person is high risk. This includes the BRCA test, the test for the presence of hereditary breast-ovarian cancer syndrome.
  • During colonoscopies, removal of a single or multiple polyps triggers preventive coverage. The entire procedure is covered as preventive.
  • Male contraceptives are not covered.
  • Plans must cover contraceptive devices such as intrauterine devices and their removal, contraceptive implants and sterilization. Employers must cover over-the-counter contraceptives if they are FDA approved and prescribed by a woman’s medical provider.
  • As part of well-woman care, annual human immunodeficiency virus (HIV)testing and triennial human papilloma virus (HPV) must be covered, as well. Men who are at high risk for HIV may be covered, as well.

Click here for a full list of the preventive care services both fully insured and self-funded healthcare must provide to both males and females. Further details regarding each area can be found by following the link at the very bottom of the PDF document.

Whether your healthcare plan is self-funded or fully insured, the ALS Group Human Capital Practice can assist you in building a more robust employee healthcare program. We can help ensure your organization is compliant with federal law and reduce your healthcare costs. If you would like to discuss how your firm is affected by the PPACA or any other human capital related question or concerns please feel free to contact me at 732.395.4251 or

Topics: HCP, Healthcare, Human Capital, Human Capital Practice, Political Risk, Risk Management Blog, Strategic Risk Management, TCoR, Total Cost of Risk, Total Cost of Risk (TCoR)

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