Preventive services

The preventive services provision of the Affordable Care Act requires coverage of certain preventive services with no cost sharing. The list of preventive services are based on recommendations by the United States Preventive Services Task Forces, the Health Resources and Services Administration and the Centers for Disease Control and Prevention and includes the latest services approved for 2018. Here is additional information that you need to know:

  • The mandate applies to all members enrolled in individual, small and large group plans (fully insured and self-funded), but not to grandfathered, Medicare, or retiree plans.
  • It became effective with plan years beginning on or after September 23, 2010.
  • Grandfathered plans can purchase Kaiser Permanente's Health Care Reform Preventive Services Package without impacting their grandfathered status.

Small businesses

As of August 1, 2012, your small business clients automatically have the new women’s preventive services added to their coverage. Adding these services doesn’t affect a plan's grandfathered status.

Large businesses

For existing groups:

  • Existing large group customers with nongrandfathered plans will have the women’s preventive services added to their coverage at their next renewal on or after August 1, 2012.
  • Existing large group customers with grandfathered plans can choose whether to purchase the Health Care Reform Preventive Services Package. Adding this package doesn’t affect a plans grandfathered status.
  • Grandfathered plans that currently cover health care reform preventive services at no cost sharing will have the women’s preventive services added to their coverage on or after August 1, 2012, as contracts renew. Adding coverage for these women’s preventive services will not cause these plans to lose their grandfathered status.

For new groups:

  • All new large groups will automatically have the Health Care Reform Preventive Services Package included in their groups plan.

For more information