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Preventive care services

Preventive care services can help you and your family members stay healthy and avoid or delay health problems. Examples of preventive care services include:

  • Yearly check-ups
  • Screenings
  • Immunizations

As a result of the Patient Protection and Affordable Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act (HCERA) of 2010, most AmeriHealth health plans include coverage for certain designated preventive care services with no cost-sharing.* This means that you do not have to pay copays, coinsurance, or deductibles. If a service is not considered preventive (e.g., diagnostic procedure, ongoing treatment for an existing condition) or you don’t fall within the coverage guidelines, charges may apply.

The requirements of the PPACA and HCERA state that services may be considered preventive when they are included as a recommendation in any of the following:

  • U.S. Preventive Services Task Force (USPSTF), A and B recommendations
  • Health Resources and Services Administration (HRSA), American Academy of Pediatrics/Bright Futures
  • Centers for Disease Control and Prevention (CDC), Advisory Committee for Immunization Practices (ACIP), Adult and Pediatric Immunization Schedules
  • U.S. Department of Health and Human Services Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children
  • U.S. Department of Health and Human Services, Women’s Preventive Services: Required Health Plan Coverage Guidelines Supported by the HRSA

Additionally, services may be considered preventive when mandated by state law. For more information, refer to the current version of medical policy 00.06.02, Preventive Care Services.

* Individual benefits must be verified.

Preventive care services

Find out what’s considered preventive. Talk to your doctor about what types of services are appropriate for you.