Great news!  Under the Patient Protection and Affordable Care Act (PPACA), non-grandfathered health plans that renew or begin on or after September 23, 2010 mandate coverage for preventive services be provided with no member cost sharing (co-payments, co-insurance or deductibles) when delivered by a network provider.  But it's not necessarily that simple...

While employers tout this new benefit and urge their employees to get their preventive care, it's important to note that only certain preventive care services are covered with no cost sharing; to be "free", preventive services must meet certain criteria:

1. Services must have a recommendation rating of A or B by the U.S. Preventive Services Task Force based on age, gender and health status; and
2. Immunizations for routine use in children, adolescents and adults must be currently recommended by the Centers for Disease Control and Prevention (CDC) and included on the CDC's immunization schedules; and
3. For infants, children and adolescents, evidence-informed preventive care and screenings must be provided for in the Health Resources and Services Administration (HRSA) guidelines; and
4. For women, evidence-informed preventive care and screening must be provided in guidelines supported by HRSA.

So exactly what is covered?  Click here for the complete list of recommended services.

Equally important, and causing much confusion among physicians and patients, is the delivery of care and resulting cost-sharing for services when preventive care is comingled with diagnostic or therapeutic care - "treatment".  Read More

Help your employees get Vaccinated! Vaccination is the best protection against contracting the flu. Everyone 6 months of age and older should get vaccinated against the flu as soon as the season vaccine is available. Below are some questions you may hear from your employees.  

Can a flu shot give you the flu?
 No, a flu shot cannot cause flu illness. The influenza viruses contained in a flu shot are inactivated (killed), which means they cannot cause infection. Flu vaccine manufacturers kill the viruses used in the vaccine during the process of making vaccine, and batches of flu vaccine are tested to make sure they are safe. In randomized, blinded studies, where some people get flu shots and others get salt-water shots, the only differences in symptoms was increased soreness in the arm and redness at the injection site among people who got the flu shot. There were no differences in terms of body aches, fever, cough, runny nose, or sore throat. 

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