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}

Blue Shield Preventative Care Guide 

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

Maybe a #Nap would help?

The psychological manifestations of fatigue, sleep and hunger are similar, as adults, we sometimes confuse them. We tend to eat when we’re actually sleepy, because we think fatigue is a sign of hunger.” Sleep deprivation “the royal route to obesity… People who don’t sleep adequately have physiologic abnormalities that may increase appetite and calorie intake ^{Sleep Foundation.org}

Insomnia results in 11.3 days/year of lost productivity, people who monitored their smart phones for business after 9 PM were more tired and less engaged the next day at work,  people are being stretched to work unreasonable hours and it’s just not sustainable,  ^{Los Angeles Times 8.9.2015}

• Insomina $63 billion drag on US Economy  LA Times 9.1.2011
• Cognitive behavior therapy — offered online by insurers — is more effective than pills  LA Times 11.3.2008
• Work emails are bad for your health LA Times 5.3.2012
• Good sleep hygiene LA Times 3.13.2012
• Napping on the Job
• medical news today.com/ Proper Sleep leads to better nutrition
• Presenteeism – being somewhere (on the job) but not really there.
• Kaiser on Sleep Management
• Anxiety shortness of breath triggerpoints self massage
  https://www.painscience.com/articles/diagnosing-shortness-of-breath.php
• Jeff Bezos from Amazon on how important eight hours of sleep is
  https://www.tomorrowsleep.com/magazine/sleep-habits-jeff-bezos/?utm_medium=paidsocial&utm_source=facebook_pro&utm_campaign=bezos_male_pro&utm_term=male&utm_content=video_1

Consumer Links & Resources

NEW Laws & Regulations effective 1.1.2017  AB 1305, 339 & 1954  SB 999 – Deductible & OOP Maximums FAQ’s

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.

Merck Manuals.com

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

https://mobile.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html?referer=http://m.facebook.com

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
  • Height, Weight Charts & BMI
  • Rambam on Diet & Hygiene
• 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

Preventative Care – ACA Mandate