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 9

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

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

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


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  *

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 Health Net will be calling and sending postcards to encourage members to get their preventative exams Vaccine Safety? Here’s an article from a friend of mine, Joel Harrison.


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   democrat and

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

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

Technical Resources – Wellness

Wellness - Final Regulations
Final Regulations

Final Regulations


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.

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

After Deployment Military Wellness Programs

Avoid the sedentary life style

  1. Study shows the short term benefits may not really be there





Technical Resources

US Preventative Services Task Force  Agency for Health Care Research & Quality

HR 3590 PPACA 2713 Page 13

California AB 2345 2010 De La Torre

Amendment to Interim Final Rules



Public Comments on Interim Final Rule

Public Comments on Amendment to Interim Final Rule

Bricker & Eckler Esq

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