Currently our self-insured plans document provides two descriptions for preventive care: benefits provided in adherence with AMA age-based guidelines or benefits provided in accordance with the Patient Protection and Affordable Care Act. When benefits provided in accordance with the Patient Protection and Affordable Care Act is the description used, the SPD states that routine preventive care encompasses those services and procedures recommended to comply with PPACA. These services include well baby/child care and immunizations. The language is currently being updated for women’s preventive care under PPACA.
With the AMA age-based guidelines, more tests and procedures are listed, because they are easily defined but we do not define them by age group (by choice). Regardless of the group, the benefits are considered voluntary in terms of the patient. We hope to enable the patient and their physician to decide which tests and procedures are appropriate or necessary, by not creating a mandatory list of procedures, which would only be used because they’re available.
Many employers, who have asked that the SPD not list all of the procedures and exams, have found this to be a concern over the years. If this is an issue for an employer, they have the option of furnishing a separate summary of preventive-care benefits via PPACA to an employee if requested. The Department of Labor website for preventive care services available under PPACA is also encompassed in your SPD.