Preventive services
Healthcare services required by ACA §2713 to be covered at $0 cost-sharing on in-network — including most screenings, immunizations, and women's health services.
ACA §2713 requires non-grandfathered plans to cover specified preventive services with NO cost-sharing — no deductible, no copay, no coinsurance. The required list comes from: USPSTF A & B recommendations, CDC ACIP immunizations, HRSA Bright Futures pediatrics, HRSA Women's Preventive Services Guidelines (including contraception). Common examples: annual physical, mammogram, colonoscopy, well-woman visit, HPV vaccine, PrEP.
Frequently asked questions
What is preventive services?
ACA §2713 requires non-grandfathered plans to cover specified preventive services with NO cost-sharing — no deductible, no copay, no coinsurance. The required list comes from: USPSTF A & B recommendations, CDC ACIP immunizations, HRSA Bright Futures pediatrics, HRSA Women's Preventive Services Guidelines (including contraception). Common examples: annual physical, mammogram, colonoscopy, well-woman visit, HPV vaccine, PrEP.
Is this relevant to a denial appeal?
Preventive services billed with cost-sharing are appealable via ACA §2713.
Related terms
Appeal a denial
Preventive services billed with cost-sharing are appealable via ACA §2713.
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