Non-grandfathered health plans (i.e., health plans issued on or after March 23, 2010) are required to cover innetwork preventive services at 100% with no cost-sharing to a member. This is a requirement that was imposed by the Affordable Care Act (ACA). The preventive services that must be covered are specified by the Health Resources and Services Administration (HRSA), the United States Preventive Services Task Force (USPSTF), and the Centers for Disease Control and Prevention (CDC).

Recently, the HRSA updated its guidelines for preventive services that non-grandfathered plans must cover for women without any cost-sharing. These services must be covered at 100% for plan years beginning on or after January 1, 2023. The new services that must be covered include:

• Counseling to prevent obesity in women aged 40 to 60 years with a normal or overweight body mass index.
• Double electric breast pumps, pump parts and maintenance, and breast milk storage supplies.
• The full range of women’s contraceptives listed in the recently updated FDA Birth Control Guide.
• Screening for HIV infection for all adolescent and adult women aged 15 and older at least once during their lifetime, and risk assessment and prevention education beginning at age 13.
• Pre-pregnancy, prenatal, postpartum, and interpregnancy well-woman visits.

The HRSA maintains information about current and updated preventive care guidelines which can be found by clicking here.