HCR Members

On March 23, 2010 the Patient Protection and Affordable Care Act (Affordable Care Act) was signed into law, which introduces reforms to health care for most Americans. Many of these reforms became effective on September 23, 2010, and include certain benefit and eligibility provisions, outlined below:

Extension of the Dependent Age Limit to 26 – Extends health benefits of covered parents to eligible dependents up to age 26. Financial dependency, residency, student status, marital status and employment status can no longer be used in the determination of an eligible dependent.

Restriction of Annual Limits – Restricts annual dollar limits on essential health benefits. (Effective until 2014. Prohibits annual dollar limit on all health benefits after 2014.)

Elimination of Lifetime Limits – Prohibits lifetime dollar limits on all health benefits.

Elimination of Pre-existing Condition Exclusion to Dependents Under 19 – Prohibits denying coverage for children under the age of 19 due to a pre-existing condition.

Inclusion of Preventive Care – Requires coverage of preventative care services with no member cost share.  The following highlights preventive care services that are covered under the Affordable Care Act. Coverage of some services may depend on age and/or risk exposure.

All Members:

  • One-a-year preventive health exams. More frequent preventive exams are covered for children up to age 3.
  • All standard immunizations adopted by the CDC.
  • Screening for colorectal cancer (age 50 - 75), high cholesterol and lipids, high blood pressure, obesity, diabetes and depression.
  • Screening for HIV and certain sexually transmitted diseases, and counseling for the prevention of sexually transmitted diseases.
  • Screening and counseling in primary care setting for alcohol misuse and tobacco use; tobacco cessation counseling in the primary care setting will be limited to eight visits per year.
  • Dietary counseling for adults with hyperlipidemia, hypertension, Type 2 diabetes, obesity, coronary artery disease and congestive heart failure; limited to six visits per year.

Women:

  • Cervical cancer screening
  • Screening of pregnant women for anemia, iron deficiency, bacteriuria, hepatitis B virus and Rh factor incompatibility.
  • Advice to promote and aid with breast-feeding.
  • Mammography screening at age 40 and over, and evaluation for genetic testing for BRCA breast cancer gene.
  • Osteoporosis screening (age 60 or older).
  • Counseling women at high risk of breast cancer for chemoprevention, including risks and benefits.

Men:

  • Prostate cancer screening at age 50 and older.
  • Abdominal aortic aneurysm screening at age 65 – 75.

Children:

  • Newborn screening for hearing, phenylketonuria (PKU), thyroid disease, sickle cell anemia and cystic fibrosis.
  • Development delays and autism screenings.
  • Iron deficiency screening.
  • Vision screening.
  • Screening for major depressive disorders.

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