PPACA: 54 Millions Getting Free Preventive Services with No Deductible or No Out-of-Pocket

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On Feb 15, 2012, HHS declared that 54 million additional Americans are receiving preventive services coverage without cost-sharing under PPACA. HHS, IRS & DOL also published The Final Rules of PPACA Preventive Care Services. ERISAclaim.com offers webinars to raise awareness for providers.

Under PPACA, healthcare providers shall advertise, educate and promote for “No Out-Of-Pocket” preventive cares for all eligible Americans, as many as 54 millions.

On Feb 15, 2012, HHS issued a brief stating that 54 million additional Americans are receiving preventive services coverage without cost-sharing under PPACA. On Feb 15, 2012, IRS, DOL and HHS also published in the Federal Register Final Rules of PPACA Preventive Services. “These final regulations are effective on April 16, 2012.” ERISAclaim.com offers new executive webinars to raise awareness for healthcare providers.

The PPACA Executive Webinar will discuss how to promote PPACA preventive service cares through community outreach educational programs and “No-Out-Of-Pocket” advertising for 54 million Americans without any cost-sharing: no deductible, no co-insurance and no co-pay at all. Doctors or healthcare providers may accept insurance payment in full. As required by PPACA, all non-Grandfathered plans must cover and pay healthcare providers for all PPACA eligible preventive services, as recommended by HHS.

“Under PPACA, healthcare providers shall advertise, educate and promote for 'No Out-Of-Pocket' preventive cares for all eligible Americans, as many as 54 millions,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

On Feb 15, 2012, IRS, DOL and HHS finally published long awaited Final Rules on Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act. (http://www.gpo.gov/fdsys/pkg/FR-2012-02-15/pdf/2012-3547.pdf)

On the same day, HHS issued a brief, titled “Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage Without Cost-Sharing Under The Affordable Care Act." In the brief, the Assistant Secretary for Planning and Evaluation (ASPE) “estimated how those 54 million people are distributed across states, and across age, race, and ethnic groups”, and “examined the following age/gender groups, and provide here a sample of the services they are now eligible for without any cost-sharing”. (http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.shtml)

The HHS Brief states:
“The Affordable Care Act requires many insurance plans (so-called ‘non-grandfathered’ plans) to provide coverage for and eliminate cost-sharing on certain recommended preventive health services, for policies renewing on or after September 23, 2010. Based primarily on guidelines from the U.S. Preventive Services Task Force, this includes services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more.”

According to ASPE, HHS, the following age group will be eligible for the following PPACA preventive service cares without any cost-sharing - no ou-of-pocket for patients, no deductible, no co-insurance, no co-pay. Please note that this is not an exhaustive list of covered services and is only meant to highlight several examples:

“Children (0-17): Coverage includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

Women (18-64): Coverage includes cancer screening such as pap smears for those ages 21 to 64, mammograms for those ages 50 to 64, and colonoscopy for those 50 to 64; recommended immunizations
such as HPV vaccination for women ages 19 to 26, flu shots for all adults, and meningococcal and pneumococcal vaccinations for high-risk adults; healthy diet counseling and obesity screening; cholesterol and
blood pressure screening; screening for sexually-transmitted infections and HIV; depression screening; and tobacco-use counseling. Starting in August 2012, additional preventive services specific to women, such as screening for gestational diabetes and contraception, will be covered by new health plans with no cost sharing.

Men (18-64): Coverage includes recommended immunizations such as flu shots for all adults and meningococcal and pneumococcal vaccinations for high-risk adults; cancer screening including colonoscopy for
adults 50 to 64; healthy diet counseling and obesity screening; cholesterol and blood pressure screening; screening for HIV; depression screening; and tobacco-use counseling.”

For a printer friendly (PDF) version (4 pages) of this HHS Issue Brief: http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.pdf

For an official copy of HHS Recommended Preventive Services 2011: http://www.healthcare.gov/law/resources/regulations/prevention/recommendations.html

“No Out-Of-Pocket for patients at all, but health plans must cover and pay doctors for PPACA preventive services. PPACA patient inducement for early preventions shall save millions of lives and billions of dollars in critical care and long term care. This Congressional inducement makes a lot of sense,” commented Dr. Zhou.

ERISAclaim.com PPACA Preventive Care Webinars will discuss the following topics:
1.    PPACA Preventive Service Regulations, Final Rule;
2.    HHS Recommended Preventive Services 2011;
3.    Strategies for how to promote “No-Out-of-Pocket” PPACA preventive care, in conjunction with conventional healthcare for healthcare providers.
4.    How to get paid for PPACA Preventive Care, as PACA & ERISA Claim Specialists

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com: http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 11 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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