Under the Affordable Care Act, consumers may access health care coverage that includes coverage of preventive care services. Many of our insurance products are designed to cover a core set of essential health benefits.
Dependent Coverage
ACA makes health insurance more widely available to dependent children. This provision requires group health plans and insurers that offer health insurance for dependent children to make coverage available for children (married or unmarried) until age 26.
Essential Health Benefits
Certain health benefits that are deemed "essential" must be offered by non-grandfathered individual plans and non-grandfathered fully insured small group plans both on and off the exchange. No lifetime maximums or annual dollar limits are allowed on these 10 essential health benefit categories as defined by a benchmark plan selected by the government:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse disorder services, including behavioral health treatment
- Prescription drugs
- Habilitative and rehabilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
Grandfathered Health Plans
A grandfathered health plan is a group health plan or health insurance coverage that was in effect (and had at least one individual enrolled) on March 23, 2010, and has not made certain changes since that date to cause a loss of grandfathered health plan status. Some of ACA requirements do not apply to grandfathered health plans.
Pre-existing Conditions
Beginning Jan.1, 2014, individuals cannot be denied coverage because of a pre-existing condition. ACA protects these individuals from having to pay higher rates or having benefits limited to exclude these conditions.
Preventive Services
ACA requires non-grandfathered health plans and policies to provide coverage for preventive care services without cost-sharing (such as coinsurance, deductible or copayment), when the member uses a network provider. Services may include screenings, immunizations, and other types of care, as recommended by the federal government.
Refer to Preventive Care on the Health and Human Services website.
Women’s Health Benefits
With the coverage provided by ACA, a number of new preventive services for women may be covered with no cost-sharing on or after Aug. 1, 2012, when using a provider in their plan/policy network. These services include:
- Well-woman visits
- Screening for gestational diabetes
- Testing for Human Papillomavirus Virus in women at least 30 years old
- Counseling for sexually transmitted infections
- Screening and counseling for Human Immunodeficiency Virus
- U.S. Food and Drug Administration approved contraception methods and counseling
- Breastfeeding support, supplies and counseling
- Interpersonal and domestic violence screening and counseling
- Contraceptive coverage