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Women's Preventative and California Health Insurance

 

Some of the mandates ushered in by Health Reform for the California health insurance market are pretty easy to get behind and the new Preventative benefits for women is one of them.

 

These newly mandated benefits will be available on health plans in California effective August 1st so you should start to see the effects now.

 

Let's take a look at what is covered including probably the biggest impact which is contraception covered at 100%.

 

The biggest thing to keep in mind is that these benefits will be available to women without having to meet a deductible or pay co-insurance or copays.

 

Essentially, this will follow in line with the preventative benefits at 100% that was established with the first roll out of preventative benefits. Keep in mind that most plans (if not all) on the California health insurance market are either PPO and HMO and you can still expect network requirements to dictate the ultimate benefit.

 

For example, 100% of women's preventative benefits will likely be covered with in-network providers. How the cariers will handle out of network preventative benefits is still being disseminated but it's safe to say that there will be out of pocket in spite of the law's requirement for 100% coverage.

 

Make sure to check with your provider if out of network to make sure you understand how this will ultimately process out on the claims side. Further more, as we understand it, grandfathered plans (those effective prior to 10/23/2012) will not have this mandated benefit.

 

Consequently, the rates for comparable core benefits are less expensive and we expect that to continue to be the case since the mandates also carry cost with them.

 

Now, let's get into the list of covered preventative benefits for women that we can now expect for the California market.
Service
 

Service	HHS Guideline for Health Insurance Coverage	Frequency
Well-woman visits.	Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate,  include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.	Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman's health status, health needs, and other risk factors.* (see note)
Screening for gestational diabetes.	Screening for gestational diabetes.	In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.
Human papillomavirus testing.	High-risk human papillomavirus DNA testing in women with normal cytology results.	Screening should begin at 30 years of age and should occur no more frequently than every 3 years.
Counseling for sexually transmitted infections.	Counseling on sexually transmitted infections for all sexually active women.	Annual.
Counseling and screening for human immune-deficiency virus.	Counseling and screening for human immune-deficiency virus infection for all sexually active women.	Annual.
Contraceptive methods and counseling.	All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.	As prescribed.
Breastfeeding support, supplies, and counseling.	Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.	In conjunction with each birth.
Screening and counseling for interpersonal and domestic violence.	Screening and counseling for interpersonal and domestic violence.	Annual.

Make sure to see your plan's policy for more detail.

 

In this list, there are two that will have the greatest effect on California women's pocket books everywhere. First, there is the well woman check up. Now this check up has already been incorporated into the first round of preventative benefits at 100% roll-out back on 3/23/2010 but the associated labs (pap mammogram) covered at 100% is a sizeable reduction in out of pocket for women that value the annual check up.

 

The real big story here and not for all the political commotion is the 100% coverage of eligible birth control. For a large percentage of adult women, this is an ongoing and potentially expensive cost which will now be covered at 100%.

 

Again, we want to stay within any pharmacy network requirements of our particular plan and it will be interesting to see how carriers address brand name or very expensive birth control medications especially when generic equivalents are available.

 

We'll need to see this in real-world claims processing on the back end to breath a sigh or relief. Other than extreme situations, we full expect to see a pretty wide swath of the birth control medication spectrum covered under the 100% preventative benefits for woman mandate effective 8/1.

 

Much like dental insurance, the bills are not generally extraordinary with these benefits but they are constant, routine, and should help promote health maintenance for women. Of course, there's always a cost which will be passed back to the consumer but the goal is for more women to take advantage of preventative benefits available to them by taking away the cost consideration. Again, we can all get behind this.
 

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