The Departments of Health and Human Services (HHS), Labor, and Treasury issued interim final regulations on July 19, 2010 requiring new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers.  The interim final regulations do not apply to grandfathered plans and issuers.  A complete copy of the proposed interim rule is available here.

Unfortunately, the rule is not real specific about what services will be considered as preventative and will have to be covered at 100%.  Instead, there is a lot of reference to the recommendations of the United States Preventative Services Task Force (USPSTF) and what it has recommended.  Presumably, the recommendations of the task force will eventually be set into rules that explain what will be the final definition of preventative care.  But don't let the broad language fool you.  The actual rules are in there.

The proposed regs provide for four classifications of preventative care that mus be covered without cost sharing arrangements (that is co-pays or deductibles).  They are:

• Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the USPSTF with respect to the individual involved.
• Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to the individual involved. A recommendation of the Advisory Committee is considered to be ‘‘in effect’’ after it has been adopted by the Director of the Centers for Disease Control and Prevention. A recommendation is considered to be for routine use if it appears on the Immunization Schedules of the Centers for Disease Control and Prevention.
• With respect to infants, children,and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA).
• With respect to women, evidence informed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force).

The point to this is that if you look at the USPSTF website, here, you find all kinds of information about A and B rated services, immunizations, counseling and screenings that are recommended based on individual patient needs.  By incorporating these recommendations into the regulations, we are essentially being told go find out that the USPSTF recommends and prepare to cover it.

Admittedly, these proposed regulations are interim and have not yet been finalized.  But a plan sponsor would do well to take the time to read them and find out what is likely going to be required once these are made final.