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Preventive Care Coverage

Preventive care coverage

There’s good news for patients visiting their doctors for preventive care – and for employers who want to keep their employees healthier. All non-grandfathered health plans now will cover the preventive health care without copays, deductibles or out-of-pocket fees.

Preventive care defined
According to the law, preventive care includes “proven” preventive services that are rated A or B by the following agencies:

  • U.S. Preventive Services Task Force
  • Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
  • Health Resources and Services Administration

To learn more, visit

Preventive care at Priority Health
Priority Health’s Preventive Health Care Guidelines are prepared by Priority Health’s clinicians and outside consultants to help members in understanding exactly what services are covered for them, based on their age and sex. Our Preventive Health Care Guidelines are updated to include all of the services required by the Affordable Care Act.

Update: Effective August 1, 2012, services will be added to Priority Health’s Preventive Health Care Guidelines to incorporate the changes affecting women’s health announced in August 2011. New supplies such as contraceptives and breast pumps will be covered with no cost-sharing by members upon renewal of their employer’s non-grandfathered health plan after August 1, 2012.

Preventive services must be included with no cost-sharing in all non-grandfathered plans. Preventive services may be covered by grandfathered plans subject to the member’s copay amount.

For NY Metro,  New England and Mid Atlantic this is one of these areas where health care reform simply requires what  has always practiced: Cover preventive care services with minimal cost sharing. The deductible has never applied. Insurers  have covered preventive at 100% on our HSA plans (Health Savings Accounts) since 2004.  Example: Oxford Preventive Health Guidelines Member Flyer

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