August 17, 2020

Preventive Care Guide

By taking a fresh look at some of the updated screening guidelines and evolving test methods, this guide will assist employers in evaluating ways to improve their members' compliance with preventive screening and remove cost barriers to accessing preventive care.

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For plan designs that come with tax-advantaged health savings accounts, employers must also follow the Internal Revenue Service (IRS) rules. These rules dictate which procedures and treatments can by-pass the deductible, but still may carry a coinsurance. Recently updated IRS guidance for high-deductible health plans (HDHPs) with health savings accounts (HSAs) expands the definition of preventive care that plans can cover before the deductible is satisfied, going beyond the original ACA list of services. The expanded list includes chronic condition treatments like beta-blockers, insulin and other glucose- lowering agents, as well as statins, among others. While screening tests for HIV, cancer, obesity and others included on the ACA list of services must still be covered without out-of-pocket costs to members regardless of their health plan design, this IRS guidance gives employers offering HDHPs with HSAs more latitude for bypassing the member deductible for claims related to medications and other services deemed preventive for certain chronic conditions.

Employers may look to design their plans so that deductible is not applied to preventive drug therapies and services to encourage adherence to preventive care and medications. Many employers rely on their pharmacy benefit manager (PBM) partners to develop preventive drug lists of medications that bypass the deductible in HDHPs. Some employers choose to customize these lists to include medications they deem preventive based on their interpretation of the rules.

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Articles & Guides Plan Design & Administration Preventive Services Primary Care