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Under the Affordable Care Act, health plans must provide coverage for preventive services for their members. Preventive services are health services that are necessary for members to maintain their health and well-being, and include things like routine physical exams and immunizations, screenings, and certain pediatric and prenatal services.
Health New England offers a wide range of preventive care services in accordance with National Health Care Reform requirements. Members must visit in-network providers to receive preventive care services with no copayment, coinsurance or deductible. Please refer to your Health New England plan materials for additional information.
Health New England covers the following preventive care services at no cost to our members when they seek care from in-network providers. Some of these services are also covered as part of routine physical exams, well visits and annual gynecological exams.
Health New England will update our list of preventive care services regularly, in accordance with changes made by the federal government under the Affordable Care Act.
For more information about preventive health services covered under the Affordable Care Act, visit https://www.healthcare.gov/coverage/preventive-care-benefits/. This site includes an overview of preventive services for all adults, women and children that all marketplace health plans must cover without charging a copayment or coinsurance.
For additional information from the Massachusetts Health Quality Partners (MHQP) about preventive care guidelines, visit http://www.mhqp.org/products_and_tools/?content_item_id=168. MHQP Adult Preventive Care Guidelines and Pediatric Preventive Care Guidelines recommend best practices in adult and child well visits and annual check-ups. Additionally, their Perinatal Care Guidelines outline best practices for routine care for pregnant women. All of these guidelines outline what patients and doctors can talk about during routine visits as well as what screening tests are recommended, depending on the patient’s age and gender.