The U.S. Departments of Labor, Health and Human Services, and Treasury have collectively issued a new series of frequently asked questions and answers primarily directed toward preventive care issues.

The new FAQs address a range of specific issues relating to the requirement that health plans (other than grandfathered plans) make coverage for preventive care available without cost-sharing. Guidance offered by the FAQs includes the following:

  • To the extent services are not available in-network, out-of-network services must be made available without cost-sharing.
  • Over-the-counter medications such as aspirin must be covered without cost-sharing where "recommended" by the designated agency and prescribed by a physician.
  • Guidance on when immunizations and a number of other specific items and services must be covered without cost-sharing.
  • Information regarding a number of women's preventive health care matters, including the scope of items and services that need to be provided without cost-sharing in connection with well-woman visits, contraception, and breastfeeding.

The new FAQs also address a few issues relating to cost-sharing limits supplementing provisions in the recently issued final regulations on essential health benefits.

As the federal health care reform effort gained steam, Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future. They also have launched the Health Care Reform Dashboard, an online resource center for news and analysis on developments under the Affordable Care Act.

If you have questions about the preventive care requirements or any other aspects of the Affordable Care Act, contact Edward I. Leeds at 215.864.8419 or leeds@ballardspahr.com.


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This alert is a periodic publication of Ballard Spahr LLP and is intended to notify recipients of new developments in the law. It should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your own attorney concerning your situation and specific legal questions you have.

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