Preventive care is one area of healthcare where it doesn’t pay for employers to cut costs on their health plan. Reason: Early diagnosis of potentially serious health issues can save a lot of heartache — and money — in the long term. But are you and your employees getting what you’ve paid for. 

 Much like medical benefits themselves, medical practices constantly evolve. In the last couple years, several medical boards and regulatory groups revised their guidelines for preventive healthcare. Has your health plan design been adjusted accordingly?

In response to the changing guidlines, many major health-plan carriers have updated their own policies to list the following treatments as preventive care under their typical plan designs:

For workers’ children and teens
The most controversial change in the guidelines: providing sexually transmitted disease (STD) screenings for adolescents. Not every carrier has elected to add STD tests as a preventive-care treatment for employees’ dependents. But, among others, many Blue Cross plans now do. Other, less publicized additions:

• Hepatitis A vaccines: two doses, spaced six months apart for all children age one year to 23 months
• Hepatitis B vaccines: three doses, given at birth, one to two months of age and six to 18 months
• Flu vaccine: annually for children age six to 59 months, usually in the fall. For the first vaccine, most plans will cover two doses, spaced one month apart, and
  rotavirus vaccines: three doses, given at two, four and six months of age.

For employees and spouses
There are several additions to the adult guidelines that many carriers have added to their preventive care benefits:
• abdominal ultrasounds. These tests are pre-approved for men age 65 and up who have ever smoked
• HIV testing. Recommended for men and women classified high-risk by a doctor, and
• gonorrhea testing. Recommended for high-risk women.
 

 First-dollar coverage
The changes mean these tests should be eligible for first-dollar coverage by the carrier even if the enrollee’s yearly deductible or out- of-pocket limit has yet to be met. That can encourage reluctant employees to seek these screenings.

Check with your company’s benefits manager, third-party administrator, and/or the carrier(s) to make sure the latest preventive care guidelines are followed under your plan.