The law is designed to encourage individuals to get exams, screenings, and tests that detect health problems in their early stages. And while the law can’t get people to go get the recommended check-ups and tests, it is meant to remove their hesitations over cost by disallowing deductibles, co-payments, or co-insurance for the specified services.

At the time of passage, the legislation left blank the list of services and governing rules. Since then, the departments of Health and Human Services (HHS), Labor and the Treasury have issued regulations and a detailed description of covered services that must now be part of every plan begun after September 23, 2010. Already existing plans, where benefits and costs remain substantially unchanged from previous years, may be grandfathered and exempt.

Under the new rules, a list of routine recommended immunizations for both adults and children was adopted from the Centers for Disease Control and Prevention. The immunization list includes hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps and rubella; meningococcal; pneumococcal; diptheria, pertussis, and tetanus; and varicella.

Health care reform guidelines also include preventive care screenings for depression, alcohol misuse, high blood pressure, colorectal cancer, Type 2 diabetes, HIV, cholesterol, obesity, and syphilis. Adult men who smoke or have smoked can also receive a one-time screening for abdominal aortic aneurysms.

Women are eligible for free screenings for osteoporosis; breast cancer through mammograms; anemia; cervical cancer; hepatitis B; chlamydia and gonorrhea. Women who are pregnant can also receive screenings for Rh incompatibility and urinary tract infections.

In addition to the screenings and tests listed here, still others appear in the HHS guidelines. A complete list that was generated by the U.S. Preventive Services Task Force is available online by clicking here.

When clarifying its rules, the HHS declared that when these services are accessed through out-of-network providers, insurers may apply their usual out-of-network charges. In a related ruling, the agency determined that if a medical appointment is made for care not included in the covered list but covered care is given during the appointment, the co-payment or co-insurance may still be charged for the appointment. However, the insurer can not add an extra charge for the preventive care given during that appointment.

Finally, ProtectPlus subscribers should take note that all the preventive services newly mandated by health care reform were already covered by their plans. Though subject to some cost sharing in the past, these services are now 100% plan paid when obtained through in-network providers.

Ensure access to quality, affordable coverage

Congress has begun to debate how to reform our nation’s health care system, and it is important for them to hear from you. It is an historic opportunity to enact comprehensive reform that makes health care more affordable, improves quality and covers all Americans.

We strongly support reform that builds a strong, sustainable private-sector health care system – and strongly oppose creating a government-run health plan. We are urging our elected officials in Washington to take bipartisan action that will accomplish that. We are educating policymakers in Washington and working with our trade associations to encourage Congress to build on the current system and not disrupt the quality, affordable coverage on which our members depend.

Our elected officials need to hear from you

There is a role that you can play in this effort, too. As our elected officials debate health care, they need to hear directly from you. You understand the important role that private-sector health plans play in ensuring access to quality, affordable coverage.

Surveys show that the American people support a common-sense approach in which the public and private sectors work together to fix the health care system. We agree. Nonetheless, there are proposals in Washington that would threaten our ability to continue serving individuals, families and employers. We cannot allow that to happen.

That is why it is important for you to get involved in our grassroots effort. Here are some steps that you can take to get involved in the health care reform debate and to ask others to participate as well.

Getting involved is easy

There are several easy opportunities to make your voice heard:

1. Go to healthactionnetwork and sign up to be a part of our grassroots campaign. When you register you will learn who your federal representatives are.
2. Write a letter. Once you register on the Health Action Network, you will have the opportunity to send an email to your elected officials.
3. Make a toll-free phone call to share your views with your federal lawmakers.  After you have registered on the Health Action Network site, you will have the opportunity to take part in a phone alert in which you will be presented with a toll-free number and a PIN to enter once you have dialed in. Your PIN will enable us to patch you through to the offices of your U.S. Senators and your U.S. Representative.
4. Post information on your Facebook page. Simply click the Facebook button provided on the Health Action Network and follow the instructions. The information will be published on your Facebook profile. Also, please be sure to become a fan of the Health Action Network on Facebook and encourage your friends and family to do the same!
5. Tell a friend. Once you have emailed your elected officials, you will have the opportunity to spread the word to family and friends by using our “Tell a Friend” feature.

The private-sector health care community is actively engaged in support of reform across the country. This effort gives all of us a chance to have our voices heard in Washington.

Thank you for your ongoing efforts in maintaining and enhancing the private-sector health care marketplace.