Recent updates from the Health Resources and Service Administration (HRSA) will result in a more comprehensive list of preventive and screening guidelines for women and children, the Department of Health and Human Services (HHS) announced on December 30, 2021. The additions, including for the first time a requirement for certain group health plans to cover electric breast pumps, increase the number of preventive services available to women with no cost-sharing.
Under the Affordable Care Act (ACA), signed into law in March 2010, certain preventive services and screenings covered by non-grandfathered health plans are available without a copay, deductible or coinsurance.
The list of preventive items includes:
- Mammograms
- Prenatal care
- Contraceptives
- Screenings for cervical cancer
The ACA provides more than 58 million women and 37 million children access to preventive services with no cost-sharing.
Preventive services guidelines are updated periodically as specified by the HRSA, the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC), and health plans generally must cover the preventive service on the first day of the new plan year following the date the guideline was put into place.
The new guidelines, as approved by the HRSA, provide updates to five existing preventive services for women and will go into effect for plan years starting on or after December 30, 2022.
See how the list compares to existing guidelines:
**** This refers to FDA’s Birth Control Guide (PDF – 450 KB) as posted on December 22, 2021, with the exception of sterilization surgery for men, which is beyond the scope of the WPSI.
Plans, insurers and providers should keep abreast of the newly released guidelines and ensure that coverage and documentation reflect the most recent changes.
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