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The Obama Administration has announced regulations requiring new health plans to provide preventive care without charging co-pays, as called for in the health care reform law.

These regulations were unveiled during a press conference on July 14, 2010, held by First Lady Michelle Obama, Dr. Jill Biden and Health and Human Services Secretary Kathleen Sebelius.

During prepared remarks, Mrs. Obama said that "getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure." She continued, "Good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother – and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them."

The regulations mandate that new health plans beginning on or after September 23, 2010 must cover preventive services that have strong scientific evidence of their health benefits. As a result, patients will no longer be charged a co-payment, co-insurance or deductible for these services when they are delivered by a network provider.

Recommendations for covered services, according to HHS, include:

Evidence-based preventive services that earn an "A" or "B" grade from the US Preventive Services Task Force, an independent panel of scientific experts that rates preventive services based on the strength of the scientific evidence documenting their benefits: Breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

Routine vaccines: Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices, ranging from routine childhood immunizations to periodic tetanus shots for adults.

Preventive care for children: Health plans will cover preventive care for children recommended under Bright Futures guidelines, developed by the Health Resources and Services Administration with the American Academy of Pediatrics. These include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight. 

Preventive care for women: Health plans will cover preventive care provided to women under both the Task Force recommendations and new guidelines being developed by an independent group of experts, which are expected to be issued by August 1, 2011.

To learn more about the ways these regulations will affect employer-provided plans, please contact your DLA Piper Employee Benefits lawyer. We will be providing an Employee Benefits Alert with further details soon.

To read our library of writings about the implications of the health care reforms, please click here.