Smoking Impacts Plan Costs
New Recommendations Made Regarding Breast Cancer Risk Reduction
Clearly Communicate "What Counts" As Out–Of–Pocket Expenses
Quick Poll – Review
February Quick Poll – Vote
Provisions of the Affordable Care Act continue to change and evolve. We at NIHP are constantly monitoring policies and trends to keep you up-to-date and in compliance. Review some of the latest guidelines, below, and let us know if we can clarify any of the ACA's rules and regulations to help you stay in-the-know.
SMOKING IMPACTS PLAN COSTS
- PLANS MAY BE REQUIRED TO PROVIDE COVERAGE FOR CT SCREENING FOR SMOKERS AND EX-SMOKERS
New recommendations by the US Preventive Services Task Force will soon require all non-grandfathered plans to cover the full cost of annual low-dose CT scans for smokers and ex-smokers who meet certain requirements. Those covered include healthy adults, ages 55 to 80 years, who have a high risk for lung cancer due to a 30 pack-per-year smoking history. They must currently smoke or have quit within the past 15 years. This population could include millions of Americans…and a large percentage of your workforce.
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Key takeaway for you? According to provisions in the Affordable Care Act, all non-grandfathered plans
must cover this preventive screening at 100% effective January 1, 2015 OR the plan's first renewal date after January 1, 2015 – with no patient responsibility – since the task force gave it a "B" grade.
- TOBACCO CESSATION CAN PROVIDE COST SAVINGS
Group health plans may charge participants a tobacco premium surcharge. This surcharge may be avoided, however, if the participant agrees to complete a tobacco cessation program. If this offer is initially declined, but later taken advantage of, the plan is not required to eliminate the year's surcharge or provide another "reward" for the plan year. Bottom line? You may allow rewards, including pro-rated rewards, for mid-year enrollment…but you are not required to do so.
NEW RECOMMENDATIONS MADE REGARDING BREAST CANCER RISK REDUCTION
Women who are at increased risk for breast cancer will now get increased coverage for risk-reducing medications like tamoxifen, as long as they are at low risk for adverse medication effects. The US Preventive Services Task Force revised its "B" recommendations as of September 2013, and accordingly, non-grandfathered group health plans will be required to cover such medications without cost sharing for plan or policy years beginning one year after the date the recommendation was issued (in this case, on or after September 24, 2014).
CLEARLY COMMUNICATE "WHAT COUNTS" AS OUT–OF–POCKET EXPENSES
What "counts" toward out-of-pocket expenses for your employees may vary dramatically from plan to plan. For example, if your plan includes a network of providers, is an individual's out-of-pocket expense for out-of-network items and services included toward the plan's annual maximum out-of-pocket limit? Is a plan required to count an individual's out-of-pocket costs for non-covered items or services toward the plan's out-of-pocket limit? (Cosmetic surgery might be an example.)
U.S. Preventive Services Task Force
Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). It conducts scientific evidence reviews of a broad range of clinical preventive health care services and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."
A Quick Review of Last Issue's "Quick Poll"
In the October 2013 issue of E to E we asked readers, "Have your employees asked you many questions about the Affordable Care Act?" Specific survey results are noted in the chart, below.
February Quick Poll – Vote