July 16, 2015

Final Rule on Free Preventive Health Services

On July 10, 2015 the administration issued final rules regarding the coverage of the preventive health services that must be covered without cost-sharing under the Affordable Care Act (ACA). Most of the attention to this final regulation has been focused on the provisions related to coverage of contraceptive services and exemptions for employers that have religious objections to such coverage. The final rules also cover other preventive services, however.


For the most part, the final rules comport with the interim final rules that have been in effect but reflect response to public feedback received about the interim final rules issued in 2010 and proposed and interim final rules issued in August 2014.


One change from the interim final rule is the final rule’s requirement that a plan or issuer will now be required to cover and may not impose cost-sharing with respect to a preventive service performed by an out-of-network provider, if the plan or issuer does not have in its network a provider who can provide the particular recommended preventive service.


The final rule can be found here. It will be published in the Federal Register here on July 14 and will be effective 60 days thereafter. Preventive services for children that must be provided without cost are listed on Healthcare.gov here. Grandfathered plans are not required to provide these preventive services free of charge.