Preventive screenings play an essential role in early detection of serious diseases and overall long-term health outcomes. Changing rules and guidelines, along with emerging screening technologies, require employers to remain vigilant about preventive service coverage provisions within their plan design. Health plans and benefits communication partners play a role in promoting the use of preventive screenings and educating members about the importance of adhering to preventive care guidelines.
Consumers generally know that their health insurance plans are required to cover 100% of the costs for preventive care. However, determining what qualifies as ‘preventive care’ is complex and can be confusing for employees. This often leads to misunderstandings about the cost-sharing rules that apply to these services as well as difficulties estimating out-of-pocket costs. In a health care landscape where many have forgone accessing health care services due to COVID-19 related concerns and may continue to be apprehensive about doing so as in person non-emergency services resume, it is more important than ever to promote appropriate adherence to evidence-based preventive care.
Preventive screenings refer to procedures like colonoscopies, mammograms and other tests that detect health problems before symptoms develop. More broadly, preventive care includes screenings as well as vaccinations, annual check-ups and wellness visits. Updates to clinical guidelines related to screening frequency, age, method or setting can lead to a change in plan coverage levels. What can be covered as a “free” preventive screening? How should employers approach creating plan designs and implementing patient support services and communications that adhere to evidence-based preventive guidelines and empower members to access them in a timely and cost-effective way?
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IntroductionEmployers' Guide to Preventive Care
Part 1Preventive Care: Regulatory Framework
Part 2Preventive Care: "Annual" Visits and Preventive Screening Considerations
Part 3Preventive Care: Role of Preventive Screenings in Managing Chronic Conditions
Part 4Preventive Care: Cancer Screening Guidelines
Part 5Preventive Care: Emerging Preventive Care Coverage Considerations
Part 6Preventive Care: Opportunities for Employers