As part of the Affordable Care Act (ACA), effective May 1, 2015, two new preventive care benefits will be available to members without cost-sharing when the services are administered by an in-network provider.
All children are at potential risk for tooth decay and may benefit from the application of fluoride varnish to their teeth. Beginning in May, the ACA requires health insurers to cover fluoride varnish applied to the baby teeth of all children ages five and younger at no cost to the member. This benefit applies to a maximum of four fluoride varnish applications per year provided by in-network primary care providers, including pediatricians. Cost sharing may apply if the member goes to an out-of-network provider. This is a medical benefit and does not apply to services provided by a dentist.
Hepatitis B Screenings*
Also beginning in May, certain members at high risk for hepatitis B infection, who are not currently showing any symptoms of the condition, may receive screening for hepatitis B at no cost to them. Examples of people at high risk for hepatitis B infection include:
- People born in regions with a high prevalence of hepatitis B infection
- U.S.-born individuals not vaccinated as infants whose parents were born in regions with a very high prevalence of hepatitis B infection, such as sub-Saharan Africa and central and Southeast Asia
- HIV-positive individuals
- Injection drug users
- Men who have sex with men
- Household members or sexual partners of people infected with hepatitis B
For more information
For more information on these benefit changes, including coding information, please refer to Harvard Pilgrim’s updated Patient Protection and Affordable Care Act (Federal Health Care Reform) policy in our online Provider Manual. In addition, visit the U.S. Preventive Services Task Force (USPSTF) online for complete information on their recommendations for the application of fluoride varnish in children in children or hepatitis B screening .
*Important Note: These changes do not apply to all employers and plans. “Grandfathered” plans may be exempt from certain provisions. Therefore, members should check with their employers to see if the benefits detailed here apply to their particular plan.