February 28, 2013
Authored by: Chris Rylands and Serena Yee
As discussed in our prior post, the Department of Treasury/IRS, Department of Labor, and the Department of Health and Human Services (the “Departments”) recently issued its twelfth set of Frequently Asked Questions addressing cost-sharing limitations and a slew of preventive services issues. The cost-sharing rules are covered in our prior post; here, we’ll discuss the preventive care rules. By way of reminder, non-grandfathered group health plans are required to cover specified preventive services. The FAQs address some open questions that were not addressed in the regulations.
Out-of-Network Services. A plan with a network is generally not required to cover preventive services out-of-network without cost-sharing. However, if a preventive service is not available from any in-network provider, then the FAQs say a plan cannot impose cost-sharing when it is obtained from an out-of-network provider.
Over-the-Counter Medications. The FAQs make clear that plans do have to cover