A health plan is allowed to use reasonable medical management techniques to determine specific coverage levels related to frequency of service, care setting, or methods of treatment, if the recommendations in force do not define these aspects of the required preventive services.

General Description of Covered Services Targeted to the Public

Comprehensive List of Services and Recommendations Included in All of the Categories

Out-of-network providers
For plans that include in and out of network providers, cost sharing such as co-pays and deductibles can continue to apply to services provided by out-of-network providers. 

Office visits
The Regulations also provide guidance and examples as to how preventive services must be covered depending on how the service is billed by the provider.  In other words, if a covered preventive care service is billed separately from an office visit, then the plan may impose cost-sharing requirements with respect to the office visit, but not the charge for the preventive service. On the other hand, if a covered preventive service is not billed separately from the office visit, and the primary purpose of the office visit is the delivery of the preventive service, then a plan may not impose cost-sharing requirements with respect to the entire office visit.

Cost Impact
The Regulations include an estimate of the cost impact the required services will have on health plan premiums.  While the cost impact on any particular plan will obviously depend largely on what preventive benefits are currently offered, overall the analysis predicts an average premium increase for all individual and group plans of 1.5%.  It is expected that individual plans will experience increases slightly above this average and group plans will experience a lower average increase.

Effective Date
Many of the covered preventive services include a recommendation as to frequency, method, treatment or setting for the provision of that service. For instance, the USPSTF recommends a one-time screening for abdominal aortic aneurysms for men of certain ages who have ever smoked. A plan may limit coverage of preventive services to correspond to these limitations.

For preventive services with USPSTF recommendations in force prior to September 23, 2009, a plan must provide coverage for plan years that begin on or after September 23, 2010.  New recommendations made after September 23, 2009 must be implemented for plan years that begin one year after the date the recommendation or guideline is issued.

Healthcare.gov includes a "date in effect" column next to each preventive service recommendation so plan sponsors will only need to visit the site once per year to determine which services must be covered with no cost-sharing.