Health Care Reform

Preventive Care

At AH, we believe as you do — whether you are a physician, hospital, administrator, or another health care professional — that quality care and prevention are vital to the long-term health and well-being of your patients.

Under the new law, a number of preventive services must now be offered without a copayment, coinsurance, or deductibles, including:

Evidence-based preventive services

These screenings are covered under the new law, without copay, coinsurance, or deductible:

  • Cancer screenings of the breast, cervix, and colon
  • Screening for vitamin deficiencies during pregnancy
  • Screenings for diabetes, high cholesterol, and high blood pressure

Routine vaccinations

These are considered routine for use on children, adolescents, and adults, and are covered: CDC List of Routine Vaccinations

Preventive care for women and children

  • Regular pediatrician visits
  • Pediatric vision and hearing screening
  • Developmental assessments for young children
  • Immunizations
  • Screening and counseling to address childhood obesity
  • For adult women, additional preventive care services such as well-woman examinations and screening for gestational diabetes. Preventive care $0 copayment capitation rates.

For members with a new $0 copayment benefits plan for preventive care services, your capitation rates will increase to account for this benefits change. The benefit and rate of capitation payment change became effective October 1, 2010, for certain commercial HMO and POS benefits plans and goes into effect January 1, 2011, for all Medicare Advantage HMO benefits plans.

Other capitation rates

For commercial and Medicare Advantage HMO members whose benefits for preventive services are not changing, the capitation rates currently in effect will continue to be paid for these members.