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New Mandates on Preventive Care

August 25th, 2010 – As part of the national Health Care Reform, new health insurance plans with effective dates on or after September 23, 2010, are supposed to cover the following preventive services without a copayment, coinsurance, or deductible, when these services are delivered by a network provider.

Covered preventive screenings for adults

  • Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol misuse screening and counseling
  • Aspirin recommended use for men and women of certain ages
  • Blood pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Depression screening for adults
  • Type 2 diabetes screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • HIV screening for all adults at higher risk
  • Immunization vaccines for adults (doses, recommended ages, and recommended populations vary):
  • Hepatitis A
  • Hepatitis B
  • Herpes zoster
  • Human papillomavirus
  • Influenza
  • Measles, mumps, rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, diphtheria, pertussis
  • Varicella
  • Obesity screening and counseling for all adults
  • Sexually transmitted infection prevention counseling for adults at higher risk
  • Tobacco use screening for all adults and cessation interventions for tobacco users
  • Syphilis screening for all adults at higher risk

Covered preventive services for women, including pregnant women

  • Anemia screening on a routine basis for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women
  • BRCA counseling about genetic testing for women at higher risk
  • Breast cancer mammography screenings every one to two years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Breastfeeding interventions to support and promote breastfeeding
  • Cervical cancer screening for sexually active women
  • Chlamydia infection screening for younger women and other women at higher risk
  • Folic acid recommended for all women planning or capable of pregnancy
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • Osteoporosis screening for women over 60, depending on risk factors
  • RH incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Syphilis screening for all pregnant women or other women at increased risk

Covered preventive services for children

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children of all ages
  • Cervical dysplasia screening for sexually active females
  • Congenital hypothyroidism screening for newborns
  • Developmental screening for children under 3, and surveillance throughout childhood
  • Dyslipidemia screening for children at higher risk of lipid disorders
  • Fluoride chemoprevention recommended for children without fluoride in their water source
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, weight, and body mass index measurements for children
  • Hematocrit or hemoglobin screening for children
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  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents at higher risk
  • Immunization vaccines for children from birth to age 18 (doses, recommended ages, and recommended populations vary):
  • Diphtheria, tetanus, pertussis
  • Haemophilus influenzae type b
  • Hepatitis A
  • Hepatitis B
  • Human papillomavirus
  • Inactivated poliovirus
  • Influenza
  • Measles, mumps, rubella
  • Meningococcal
  • Pneumococcal
  • Rotavirus
  • Varicella
  • Iron recommended for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Medical history for all children throughout development
  • Obesity screening and counseling
  • Oral health risk assessment for young children
  • Phenylketonuria screening for this genetic disorder in newborns
  • Sexually transmitted infection prevention counseling for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis
  • Vision screening for all children

Colorado state-mandated preventive care services are in addition to those required by federal health care reform.

Additional State-mandated services

  • Breast cancer screenings for all at-risk individuals regardless of age
  • Colorectal cancer screenings for all at-risk individuals regardless of age

NOTE:  The information provided is informational and non-binding.  The information presented is intended to provide a brief outline of coverage. All terms and conditions of coverage, including benefits and exclusions, are contained in your Insurance Policy or Certificate, which shall control in the event of a conflict with this overview.

{ 2 comments… add one }
  • Chris Leonard November 9, 2010, 1:57 pm

    I had heard that one of the state mandates was that Pap Smears (at least the lab work) is now covered for women. Is that not true?
    And is the cost of mammography covered include the hospital charges as well as the radiologist charge for reading the results? Thanks so much for your help

    • Mark November 9, 2010, 3:35 pm

      That’s an excellent question Chris. To the best of my knowledge there are no changes in coverage for Pap exams or mammograms.

      Of course, you want to check your policy for exact benefits, but according to the Colorado Revised Statues 10-16-104, Group and individual plans are minimally required to cover:

      “(II) Cervical cancer screening;
      (III) (A) Breast cancer screening with mammography.
      (B) Coverage for breast cancer screening with mammography shall be the lesser of one hundred dollars per mammography screening or the actual charge for such screening, but in no case shall the covered person be required to pay more than the copayment required by the policy or contract for preventive health care services. The minimum benefit required under this subparagraph (III) shall be adjusted to reflect increases and decreases in the consumer price index.
      (C) Benefits for preventive mammography screenings shall be determined on a calendar year or a contract year basis, which shall be specified in the policy or contract. The preventive and diagnostic coverages provided pursuant to this subparagraph (III) shall in no way diminish or limit diagnostic benefits otherwise allowable under a policy. If a covered person who is eligible for a preventive mammography screening benefit pursuant to this subparagraph (III) has not utilized such benefit during a calendar year or a contract year, then the coverage shall apply to one diagnostic screening for that year. If more than one diagnostic screening is provided for the covered person in a given calendar year or contract year, the other diagnostic service benefit provisions in the policy or contract shall apply with respect to the additional screenings.
      (D) Notwithstanding the A or B recommendations of the task force, an annual breast cancer screening with mammography shall be covered for all individuals possessing at least one risk factor including, but not limited to, a family history of breast cancer, being forty years of age or older, or a genetic predisposition to breast cancer.

      Note: Sub-subparagraph (D) is effective January 1, 2011.”

      So, it appears women may still be responsible for paying for the lab work associated with the Pap exam, if the policy only covers the minimums.

      Again, these are the minimum coverage requirements. Some plans will pay for the Pap exam, lab work and complete preventive mammography, while others may only provide the minimum benefits.

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