California health
insurance
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Health insurance
articles for California
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Women's Preventative benefits
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.
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!