What does Valentine’s Day and preventive care services have in common? Love. To take care of ones’ health is an expression of love for ones’ self. After all, it is one of the few things only we can do for ourselves. And with the implementation of the Affordable Care Act, it’s more affordable to get routine check-ups done, because most services are free!
List of Preventive Care Services:
For all Members:
• Everyone, whether an adult or child, are entitled to one routine physical exam1 in a 12-month period.
• Cholesterol screenings
• Colorectal cancer screenings, including flexible sigmoidoscopy for adults older than 50
• Type 2 diabetes screenings
• Family planning visits2
• Health education programs that can help you take an active role in protecting and improving your health, including programs for stress management, chronic conditions like diabetes and asthma, and smoking cessation
• Hearing tests to determine the need for hearing correction
• Immunizations (excluding travel vaccinations)
• Prostate cancer screenings, including prostate-specific antigen (PSA) tests
• Refraction exams to determine the need for vision correction and to provide a prescription for eyeglass lenses2
• Sexually transmitted disease (STD) screenings (including HIV, Chlamydia, gonorrhea, herpes, and syphilis screenings)
• Tobacco use screenings for all adults, and help quitting smoking
• Well-woman office visit per 12-month period with an obstetrician/gynecologist.
• Breast cancer mammography screenings every one to two years for women older than 40
• Cervical cancer screenings
• Osteoporosis screenings for women older than 65, depending on risk factors
• Scheduled prenatal visits, as well as the first postpartum visit
• Children under age 2 are entitled to additional well-baby visits.
• Autism screenings at 18 and 24 months
• Developmental screenings for children younger than 3, and monitoring throughout childhood
• Hearing screenings for all newborns
• Immunizations from birth to 18 (excluding travel vaccinations)
• Obesity screenings and counseling
• Oral health risk assessments for young children
• Sexually transmitted disease (STD) screenings and prevention counseling for adolescents
• Vision screenings for all children
1 – Physical exams required by the courts, Department of Motor Vehicles (DMV), or for employment
are not considered “routine physical exams” and are, therefore, chargeable services.
2 – For Kaiser Permanente HSA Plans, this service is subject to the deductible.
When Do the New Preventive Care Provisions Apply?
The preventative care provisions apply to medical plans that were purchased either through an employer or privately, on are after March 23, 2010. Policies that were in effect prior to March 23, 2010 will be affected on the renewal date on or after September 23, 2010. Grandfathered plans are not subject to the Health Reform provisions. For Kaiser Permanente however, many of their plans have been revised to adopt the preventive care provisions regardless of the policy effective dates.
Are There Exceptions?
Medical coverage plans that use a network of providers may have an exclusion that makes the preventive care chargeable if you receive services from an out-of-network provider. It is common for coverage benefits to be diminished when services are received from a provider who is outside of the network, so this is common practice.
Taking care of our routine health exams is something only we can do for ourselves. So this Valentine’s Day, take time to give yourself a little love.
For questions, contact your health care provider, or your State insurance department.