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Blog

Good Neighbor Travel Insurance Blog

Frequently asked questions and answers on preventive care, 2011 – Part 1

January 5, 2011 By : Doug Gulleson

Good Neighbor Insurance (www.gninsurance.com and www.gninsurance.com) is continuing to update our clients on the new health insurance laws.   There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work.  Many critical details of this new insurance law will be clarified in the months and years to come.

These six major coverage options are:

(1) Individual or family coverage (private health care plans)

(2) Employee/employer group option for small businesses (typically under 50 employees)

(3) Employee/employer group option for large businesses (typically larger than 50 employees)

(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)

(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards

(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.

Some plans cover preventive care after an office visit copay. Can a copay still apply or must coverage be at 100%?
The regulations clarified that co-pays, deductibles and coinsurance are not permitted for preventive care services. If a plan uses a provider network, coverage is required at the in-network level only. Coverage of preventive care is permitted but not required out-of-network. If coverage is provided out-of-network, it can be subject to co-pays, deductibles, and coinsurance.

It appears that the preventive care legislation actually does not impact grandfathered plans. Please clarify this.
The prohibition on cost-sharing for preventive care does not apply to a grandfathered plan. Any plan in effect on March 23, 2010 would be a grandfathered plan, and the prohibition on cost-sharing for preventive care would not apply as long as the plan maintains its grandfathered status. Events that might cause a plan to lose its grandfathered status in the future have been clarified in regulations provided by the Secretary of Health and Human Services.

My plan covers preventive care at 100% up to a plan year maximum of $600. Charges that exceed the maximum then apply towards coinsurance (no deductible). How will the legislation impact that benefit?
Because preventive care is considered an essential health benefit, an annual or lifetime dollar limit is not permitted in-network. In addition, application of coinsurance to charges for preventive care services exceeding $600 would not be permitted under the in-network coverage.

My understanding of cost-sharing is that the customer will not have to pay a copay / coinsurance / deductible for preventive services. Do you know if this applies to both in-network and out-of-network doctors, or to in-network doctors only?
The PPACA regulations clarified that a plan can satisfy this requirement by eliminating patient out-of-pocket expenses solely for in-network preventive care services.

When will this no-cost-sharing-for-preventive-care requirement take effect?
The no-cost-sharing-for-preventive-care health requirement is effective for plan years beginning on or after September 23, 2010 (October 1, 2010 for plan years beginning on October 1, 2010), but is not applicable to grandfathered plans.

How is the recent healthcare reform legislation affecting vaccinations and the delivery of vaccines?
Under the new health care reform law, all non-grandfathered health plans will be required to provide a preventive benefit package that covers routine immunizations. Regulations from the Secretary of Health and Human Services require coverage of all immunizations and vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP).

Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, www.gninsurance.com , information with him at all times when he travels   Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the US health care system.

Doug Gulleson

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Travel update: Chikungunya. It’s landed in America from the Caribbean. And it’s spread by local varieties of mosquito. And while it won’t kill you like the ebola virus spreading all over West Africa, the chikungunya virus can cause such extreme joint pain that you can’t even sit up for weeks. And there is no cure. […]

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Interesting tourism and international travel medical facts from 2010 – 2012

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PPACA Q&A – Global Citizen/Global Navigator international career health insurance

September 11, 2013

Good Neighbor Insurance brokerage firm (https://www.gninsurance.com/), out of Phoenix Arizona, is a world class leader in providing international health insurance benefits to our guests traveling and residing outside the U.S. since 1997.  In fact, our mission statement states:  Good Neighbor Insurance serves and protects travelers, expatriates and international organizations, using professional and overseas experience to […]

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Two new Weight Loss Drugs You May Not Know About

May 20, 2014

Good Neighbor Insurance works on keeping our guests, you, up-to-date with health insurance news as well as information that our insurance carriers provide to us in the form of updates on medical care and medical Rx.  Blue Cross provided some great information to us this week that we want to share with you. Thirteen years […]

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Second quake hits Nepal

May 12, 2015

Relief workers and locals were struggling to supply clean water and begin rebuilding just before this second quake hits Nepal and leaves even more fear and destruction in its wake. A 7.3 (richter scale) second quake hits Nepal, near the town of Namche Bazaar (see photo below), just after noon on Tuesday, May 12, local […]

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Expatriate medical insurance and overseas travel insurance for those with U.S. Medicare – Part 2. 

February 15, 2018

Expatriate medical insurance and overseas travel insurance for those with U.S. Medicare – Part 2.  Good Neighbor Insurance has been asked over the years how does U.S. Medicare work?  Many of our long term, expatriate, clients who reside for many years outside the U.S. have some idea of how U.S. Medicare works but not fully.  The […]

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