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Preventative Services (PPACA)

Private health insurance plans must provide for three general types of preventative services:

  • Evidence-based services rated A or B by the U.S. Preventative Services Task Force
  • Routine Immunizations
  • Preventative services recommended for children and youth by the federal Health Resources and Services Administration’s Bright Future Project.  In June 2014 the Supreme Court held in the Burwell vs. Hobby Lobby decision that some closely-held for-profit corporations may exclude contraceptive coverage from their health plans if this requirement clashes with their religious beliefs. Certain religious non-profit organizations are also exempt from this requirement.

Through Medicaid, the Affordable Care Act provides states that offer coverage for recommended preventative services with no cost sharing a one percentage point increase in the Federal Medical Assistance Percentage for those services. Since January 30, 2014 ten states, including Colorado, have submitted State Plan Amendments to cover all preventative services (8 have been approved).

In April of 2016, the U.S. Department of Labor released the final Summary of Benefits and Coverage Form for use on or after April 1, 2017. The SBC form is used to help consumers understand their health coverage plans.