Preventive Services – Coverage at 100%

Section 2713 of the PPACA (the new health care reform law) requires coverage of certain preventive health services with no cost sharing. In other words, these screenings, tests, immunizations, and other services must be covered at 100%, with no application of deductibles and co-payments or co-insurance. The new rule becomes effective for a group health plan on its first plan year on or after October 1, 2010. (A calendar year plan would be subject to the new rule on January 1, 2011, for example.)

The required coverages are the minimum a plan must provide. A plan can provide coverage for other types of preventive care (subject to other reform provisions, such as the 40% excise/Cadillac tax on group health plans with a high value, which applies in 2018).  Preventive Services PDF Download