Health reform update

The Patient Protection and Affordable Care Act has brought about many changes to health benefits. While the majority of these changes impact the employer and the insurer, still others are of interest to providers. Here’s an overview of some of the reforms that are effective this year.

Expansion of preventive services
Three federal agencies were charged with developing the list of recommended preventive services. Because Priority Health has long offered comprehensive coverage of preventive care, there is little change to our Preventive Health Care Guidelines. For the most part, the only difference will be in cost-sharing. Under the new law, preventive services are covered at 100% (with no cost-sharing such as copays or coinsurance).

Members whose health plans are “grandfathered” will still be required to pay cost-sharing on preventive services. Check Member Inquiry or call the Provider Helpline at 800 942-4765 with questions about a member’s benefit level.

Selection of PCP
Under reform, women can select their OB/GYN as their primary care provider. Parents can select a pediatrician as their child’s PCP. Additionally, women can see an OB/GYN without referral or prior authorization. Priority Health already complies with this requirement.

Reforms impacting your business
We recognize that in addition to being a valued member of the Priority Health provider network, you may also be a business owner offering health benefits to your employees. If you have questions about how reform impacts your business, find answers at our new website: understandinghealthreform.com. Here you’ll find descriptions of the major reform requirements, a small business tax credit calculator and a decision tree to help you determine if your existing plan qualifies as a “grandfathered” plan.

Stay informed
We’ll continue to include health reform updates in future issues of the Provider Packet. Be sure to visit the Provider Center for additional information.

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