A group health plan must cover a new or updated recommended preventive service starting in the plan year that begins on or after exactly one year from the issue date.
The Affordable Care Act's (ACA) preventive services mandate for non-grandfathered plans requires certain preventive services be covered in-network without cost-sharing for plan participants. The ACA uses the following when determining the preventive services that must be covered:
- Evidence-based items or services rated A or B in the United States Preventive Services Task Force (USPSTF) recommendations.
- Recommendations of the Advisory Committee on Immunization Practices adopted by the Director of the Centers for Disease Control and Prevention (CDC).
- Comprehensive guidelines for infants, children, and adolescents supported by the Health Resources and Services Administration (HRSA).
- Comprehensive guidelines for women supported by the Health Resources and Services Administration (HRSA) that are not otherwise addressed by the recommendations of the USPSTF.
The final preventive services regulations, issued in July 2015, contain guidelines for when plans must incorporate any modified recommendations. A group health plan must cover a new or updated recommended preventive service starting in the plan year that begins on or after exactly one year from the issue date.
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