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Updates to UHC's Preventive Care Services Benefit

Sep 25, 2014

Under health reform, non-grandfathered health plans are required to cover certain preventive care services without cost-sharing, as long as these services are provided by network doctors and health care professionals. 

UnitedHealthcare is updating its approach to several preventive care services. The following changes will be reflected in future versions of the Preventive Care Services Coverage Determination Guideline (CDG). 

Age Limits Applied to Cervical Cancer and Colorectal Cancer Screenings Effective January 1, 2015

UnitedHealthcare will now apply age limits to cervical cancer and colorectal cancer screenings without cost-share effective January 1 to align with guidance from the U.S. Preventive Services Task Force (USPSTF) and Bright Futures/American Academy of Pediatrics periodicity schedule. 

Cervical cancer screenings will be covered without cost-share for women ages 21-65 years (ends on 66th birthday). Cost-sharing will apply for those outside these age limits. 

Colorectal cancer screenings will be covered without cost-share for adults ages 50-75 years (ends on 76th birthday). Cost-sharing will apply for those outside these age limits. 

Limiting the Age for Autism Screening to 0–2 Years Effective January 1
Effective January 1, UnitedHealthcare is limiting the age for autism screening without cost-share to 0-2 years (ending on 3rd birthday) to align with guidance from the Bright Futures/American Academy of Pediatrics periodicity schedule recommendation. Previously, autism screening was covered for ages 0-21 years without cost-share. 

Covering Annual Lung Cancer Screening with Low-dose Computed Tomography Effective January 1, 2015

Beginning January 1, 2015, UnitedHealthcare will cover an annual lung cancer screening with low-dose computed tomography without cost-share for those at high risk for lung cancer based on age and smoking history as recommended by the USPSTF:

Today, UnitedHealthcare covers lung cancer screening as a diagnostic service for heavy smokers and former smokers, subject to Prior Authorization review.   

Adding Fluoride Varnish as a Preventive Benefit for Children Effective January 1, 2015

UnitedHealthcare is adding fluoride varnish as a preventive benefit for children 0-6 years old (ending on 7th birthday) when provided in primary care settings on January 1, 2015, to align with the USPSTF and Bright Futures/American Academy of Pediatrics periodicity schedule. This benefit does not apply to dental office visits. Today, UnitedHealthcare does not cover fluoride varnish without cost-share. 

Adding Hepatitis B Screening in Non-pregnant Women Effective April 1, 2015
UnitedHealthcare is adding hepatitis B virus infection screening as a preventive benefit for at-risk non-pregnant adolescents and adults beginning April 1, 2015, in response to the USPSTF recommendation. Today, UnitedHealthcare covers hepatitis B screening in pregnant women following the existing USPSTF recommendation. 

To find what UnitedHealthcare covers as a preventive benefit for its standard plans, review UnitedHealthcare’s Preventive Care Servic​es CDG.

For questions or assistance regarding the information above, please ​contact a member of your b&p Sales Team - 888.722.3373.

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