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42 U.S.C. § 300gg–13 — Coverage of preventive health services

submitted 82 years ago by Pub. L. 111-148 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 358 words · no verdicts yet

in plain englishAI-generated · not legal advice

Health plans must fully cover certain preventive care with no cost-sharing at all. This includes highly-rated preventive services, recommended vaccines, and extra screenings for children and women. New recommendations don't take effect for at least a year, giving plans time to update coverage.

(a) In general A group health plan and a health insurance issuer must cover, at a minimum, and can't charge any cost-sharing for: evidence-based items and services currently rated "A" or "B" by the U.S. Preventive Services Task Force; vaccines currently recommended by the CDC's Advisory Committee on Immunization Practices for the person getting them; for infants, children, and adolescents, evidence-informed preventive care and screenings from the comprehensive guidelines supported by the Health Resources and Services Administration; and for women, additional preventive care and screenings — beyond what's already covered above — from HRSA-supported guidelines for women. For this law and any other law, the "current" Task Force recommendations on breast cancer screening, mammography, and prevention are the most recent ones — except recommendations issued around November 2009, which don't count as current. None of this stops a plan from covering more than the Task Force recommends, or from denying coverage for something the Task Force doesn't recommend. (b) Interval The Secretary must set a minimum waiting period between when a new recommendation or guideline comes out and when plans must start covering the service it applies to. That waiting period can't be shorter than 1 year. (c) Value-based insurance design The Secretary may issue guidelines letting plans and issuers use "value-based" insurance designs — approaches that adjust member cost-sharing based on the value of a service — for this coverage.
the actual law source: uscode.house.gov ↗public domain
(a) In general

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for—

(1)

evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force;

(2)

immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and 1

(3)

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.1

(4)

with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.1

(5)

for the purposes of this chapter, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.

(b) Interval
(1) In general

The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline.

(2) Minimum

The interval described in paragraph (1) shall not be less than 1 year.

(c) Value-based insurance design

The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2713, as added Pub. L. 111–148, title I, § 1001(5), Mar. 23, 2010, 124 Stat. 131.)

history & why it existsrecord from the source credit
  • 1944Enacted · Pub. L. 111-148 · 124 Stat. 131

A history note hasn’t been published yet. The record shows enactment by Pub. L. 111-148 on 1944-07-01.

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