Preventative Care & Wellness Programs
Here’s a Plain English List! from Health Care.Gov and Blue Shield of preventative services you can get with NO DEDUCTIBLE.
However, if Preventive care is given during an Office Visit or as an outpatient it might not be covered that under the Preventative Care section of your policy. Check with your doctor. Preventative Screenings and other services are covered with no deductible for adults and children with no current symptoms or history of a health problem. Specimen Policy Page 92
If one has history or symptoms, then it’s covered under the diagnostic benefit Page 74 Subject to Co-Pays & the Deductible. Maintenance of a known problem, like those listed below as common risk factors, is certainly preventative, but isn’t defined that way under ObamaCare and is subject to the regular co-pays and deductibles. Peter Lee of Covered CA thinks that’s a BIG problem, read more by on the link. Annual physicals may not be a benefit LA Times 8.2.2016
Health Care Reform hopes to save premium dollars as 20% of Employee Health Care Spending is on these common risk factors: health net pulse.com/
- stress
- ♦ depression
- ♦ high blood pressure
- ♦ high cholesterol
- ♦ high blood glucose
- ♦ obesity
- ♦ tobacco use
- ♦ poor diet
- ♦ physical inactivity
- ♦ excessive alcohol use
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DOL FAQ’s 12.20.2016 * PHS Section 2713 * KFF.org
Kaiser Permanente – 5.2017 Preventative Care
Our Webpage on Medicare Preventative Services
Kaiser Foundation Preventative Services Tracker ♦ Fact Sheet
Health Net Brochure on preventative services
Specimen Evidence of Coverage – Platinum Page 92 – Preventative Care
Arthur Gallagher – FAQ‘s pdf
Blue Shield 9 page pdf showing covered services
Women’s Preventative Services – US Health & Human Services Dept.
Los Angeles Times 9.8.2014 – Many people miss out on FREE Preventative care and initial MD visits in Bronze, Silver & Enhanced Silver. LA Times 9.25.2015
Smart Phones latimes.com Health Net will be calling and sending postcards to encourage members to get their preventative exams exacttarget.com Vaccine Safety? Here’s an article from a friend of mine, Joel Harrison. benthamscience.com
New York Times article that preventative care may not save any money overall
Wellness programs
are Mandated as an Essential Health Benefit Section I. Final Regulations will increase the greatest permissible reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of health coverage, and that further increase the largest reward to as much as 50 percent for programs designed to prevent or cut tobacco use. (Fact Sheet) * Health Net Q&A 8.9.2013 Kaiser Health Reform Summary last page Dubai is paying $40/pound of weight loss CNN
How will Covered California health insurance companies improve quality of care?
Covered California and each health insurance company selected are committed to ensuring high quality of care for all enrollees. Specifically, each health insurance plan must:
- ensure that each enrollee has had a preventive health and wellness visit during the first year of enrollment
- identify and proactively manage all “at-risk” enrollees [pre-existing conditions]
- determine each enrollee’s health status and proactively develop a plan to manage their individual health care needs
- promote the use of best practice models for continuity of care and care coordination that are proven to improve quality of care
- be transparent about plan performance at the point of enrollment, specifically regarding standard measures of prevention, access and clinical effectiveness
- be certified by the National Committee for Quality Assurance or URAC (formerly known as the Utilization Review Accreditation Commission) to meet quality standards Covered CA Tentative Rate & Plan Guide Page 8
Health Care Reform – MANDATES Chain Restaurants to provide calories on the Menu! Page 455 Section 4205 HR 3590 Final Rule Wellness incentives can only be to encourage participation not penalize if goals are not met bizjournals.com democrat and chronicle.com
29 CFR 2590.702 Health Factors
California Department of Public Health and the state Health and Human Services Agency selected 23 initiatives aimed at supporting California’s goal to become the healthiest state in the country by 2022, the Half Moon Bay Review reports. CA Healthline 1.7.2016
I expect to see “mandates” that one keep healthy. One of these is bike lanes. LA Times Article
More pages on our Websites on
Wellness & Preventative Care
Wellness – Keep healthy – best use of coverage
- Insomnia – Proper Rest & Sleep
- Nutrition & Weight Control
- Wellness & Preventive Care – Introduction
- Wellness General Research
Anthem Blue Cross Administrative, Renewal & Wellness Tools
Health Net Administrative, Wellness & Renewal Tools
United Health Care Administration & Wellness
Medicare Preventative Care – Wellness Visit
Regulations
- July 19, 2010 OCIIO–9992–IFC: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act
- August 3, 2011 CMS-9992-IFC2: Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act – Opens in a new window (PDF – 201 KB)
- February 10, 2012 CMS-9992-F: Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act – Opens in a new window (PDF – 164 KB)
- March 21, 2012 CMS 9968-ANPRM: Preventive Services Under the Affordable Care Act – Opens in a new window (PDF – 263 KB)
- February 6, 2013 CMS-9968-P: Coverage of Certain Preventive Services Under the Affordable Care Act – Opens in a new window
- June 28, 2013 CMS-9968-F: Coverage of Certain Preventive Services Under the Affordable Care Act – Opens in a new window
- July 19, 2010 Recommendation: Recommendations of the U.S. Preventive Service Task Force – Opens in a new window
- June 28, 2013 Guidelines: HRSA’s Women’s Preventive Services: Required Health Plan Coverage Guidelines – Opens in a new window
- June, 28, 2013 CCIIO Technical Guidance: Guidance on the Temporary Enforcement Safe Harbor for Certain Employers, Group Health Plans and Group Health Insurance Issuers with Respect to the Requirement to Cover Contraceptive Services Without Cost Sharing Under Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act, and Section 9815(a)(1) of the Internal Revenue Code (PDF – 177 KB)
Technical Resources – Wellness

IRS Regulation 122707-12 Wellness Programs – Proposed
amendments to regulations, regarding nondiscriminatory wellness programs, clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer to avoid prohibited discrimination.
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Study Press Release HHS Proposed Regulation – Health Insurance Market Rules Better Health – Nutrition Cancer Society Explanation
CA Law SB 189 (Amended 4.22.2013) pdf might prohibit discounts. Life Health Pro article Has been “defeated” 5.20.2013 sb_189.prohibit.discounts.4.wellness SB 622 2013 Moning
29 CFR 2590.702 Health Factors
Deport Fat People to keep costs down?
New website on dangers of added sugar http://sugarscience.org/
After Deployment Military Wellness Programs http://afterdeployment.dcoe.mil/home
Avoid the sedentary life style latimes.com/
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Study shows the short term benefits may not really be there
https://www.latimes.com/business/la-fi-workplace-wellness-programs-20190418-story.html
Technical Resources
US Preventative Services Task Force
ahrq.gov Agency for Health Care Research & Quality
HR 3590 PPACA 2713 Page 13
whitehouse.gov/
California AB 2345 2010 De La Torre
Amendment to Interim Final Rules
Regulation
Public Comments on Interim Final Rule