Health Care Reform: Wellness and Prevention

Recent statistics prove that too many people in this country do not obtain the preventive health care needed to stay healthy or avoid or delay the onset of disease. Not only does a healthy lifestyle help us lead productive lives and reduce health care costs, but it also helps prevent chronic diseases such as heart disease, diabetes and cancer. The key to success for wellness and prevention programs is to make the resources for achieving a healthy lifestyle affordable and accessible to the general population.

In accordance with the regulations mandated by National Health Care Reform (e.g. the Affordable Act) most group health plans are required to provide coverage for certain preventive services, such a screenings and immunizations, with no cost-sharing to the covered member. No cost-sharing means simply that, as long as the preventive treatment received is performed by a participating network provider, the health plan may not require you to pay any copayments, deductibles or coinsurance for that service. This provision does not apply if treatment is received by a non-network provider.

In most circumstances, this provision takes effect for employer sponsored health plans that renew after September 23, 2010. There are a few exemptions to this rule, not all employer plans are required to comply such as “grandfathered” plans, but most plans must comply whether the plan is fully-insured or self-insured.
Depending on your age and health plan type, you may have easier access to services such as blood pressure and diabetes screenings, cholesterol tests and many cancer screenings. Included in the list of covered preventive services are:

• Routine vaccines for diseases such as measles, polio, or meningitis
• Flu and pneumonia shots
• Screening and vaccines for healthy pregnancies
• Regular well-baby and well-child visits, from birth to age 21.

Effective January 1, 2011 Medicare will also be enhanced to provide coverage for certain free preventive services including annual wellness visits. Five-year grants will also be made available to small employers who establish a formal wellness program at work.

This program is intended to encourage all of us to get the care we need. By promoting healthy pregnancy and keeping children healthy, preventing heart disease and obesity, and preventing and controlling breast cancer, the hope is that people will lead healthier lives, and thus, health care costs will be reduced as a whole. There is also a new $15 billion Prevention and Public Health Fund that will invest in proven prevention and public health programs that can help keep us healthy – from smoking cessation to combating obesity treating depression, and reducing alcohol use.

Wellness and prevention are one of several initiatives of the Accordable Act intended not only to make healthcare accessible and affordable to all of us but also to provide education on how to stay healthy. For more information about government programs such as “Let’s Move” and other programs to learn to get and stay healthy, and other programs to learn to get and stay healthy.

About The Author

Mary Rose is the Vice President, Group Benefits Advisors for Sapers & Wallack, Inc. Rose has direct responsibility for several clients advising them on all aspects of employee benefit plans and strategies providing innovative, competitive and cost-effective solutions. Rose specializes in technical compliance for employee benefits and, as our Technical Advisor and HIPAA Privacy Officer; she assists our clients to comply with these concerns including COBRA and FMLA. Rose has been with Sapers & Wallack since 1989. She is a graduate of the University of Vermont and is currently working on her CEBS designation to become a Certified Employee Benefits Specialist. She is also a member of the New England Employee Benefits Council. She can be reached for additional questions at mrose@sapers-wallack.com or 617-225-2600.