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Health & Welfare Plans Newsletter

BULLETIN
April 13, 2023

 

[Official Guidance]

Text of Agency FAQs Part 59: Coverage of Preventive Services

"The Departments disagree with the District Court's ruling and are considering all available options in consultation with the Department of Justice; the Department of Justice filed a notice of appeal on March 31, 2023, and a motion for a stay on April 12, 2023.

"The Departments are issuing these FAQs to provide initial guidance on how the Braidwood decision affects the requirement to cover preventive services without cost sharing under PHS Act section 2713. The Departments anticipate issuing additional guidance in the future to further address plans' and issuers' obligations under PHS Act section 2713(a)(1) in light of the Braidwood decision.

  1. Which USPSTF-recommended items and services are affected by the Braidwood decision?
  2. Following the Braidwood decision, are plans and issuers required under PHS Act section 2713 to continue to provide coverage, without cost sharing, for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?
  3. Does the Braidwood decision affect the requirements under PHS Act section 2713(a)(2)-(4) to provide coverage without cost sharing for immunizations recommended by ACIP or preventive care and screenings for infants, children, and adolescents, as well as for women as provided for in comprehensive guidelines supported by HRSA?
  4. Does the Braidwood decision prevent states from enacting or enforcing state laws that require health insurance issuers offering group or individual health insurance coverage to provide coverage, without cost sharing, for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?
  5. To the extent a plan or issuer is permitted and elects to make changes to its coverage, may it make those changes in the middle of the plan or policy year?
  6. Must plans and issuers notify participants, beneficiaries, and enrollees if they change the terms of their coverage with respect to USPSTF-recommended items and services that were affected by the Braidwood decision?
  7. Following the Braidwood decision, may an HDHP continue to provide benefits for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010 before the minimum annual deductible under Code section 223 has been met?
  8. How does the Braidwood decision affect the requirement under CARES Act section 3203 to cover qualifying coronavirus preventive services?
  9. Are carriers offering plans in the Federal Employees Health Benefits Program required to continue to cover items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?"

   MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

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BenefitsLink® Retirement Plans Newsletter, ISSN no. 1536-9587.

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