Most LifeWise health plans cover preventive care including routine exams, immunizations and screenings at a reduced cost when you use an in-network provider. Under new healthcare reform regulations and guidance received from the Department of Health and Human Services, the list of preventive care services that are covered in full when you obtain care from an in-network provider will expand for non-grandfathered plans. These new requirements only apply to non-grandfathered plans beginning:
- Sept. 1 2011 for LifeWise individual health plans.*
- Aug. 1, 2011 for LifeWise portability health plans.*
- With plan years that begin on or after Oct. 1, 2010 for employer-sponsored health plans.
Is there a list of covered preventive care services?
- You can find a list of preventive care services applicable to you in our secure member website. Log in at lifewiseor.com and you will find a list of preventive care services under the “My plan information” section.
- If you have questions about specific exams, immunizations or screenings, you can also access your plan’s benefit booklet in our secure member website under the “Benefits” section or call Customer Service at 800-596-3440.
How will I know if I have a non-grandfathered or grandfathered health plan?
- In general, a plan may be non-grandfathered if it is new or became effective after Mar. 23, 2010. If you were a LifeWise individual health plan member as of Mar. 23, 2010, and you have not made any changes to your plan since then, your plan is grandfathered.
- If you have an employer-sponsored health plan, you may wish to check with your benefits administrator about whether your plan is grandfathered.
More about grandfathering
Will I have to pay a copay, coinsurance or deductible for preventive care?
- If your health plan is non-grandfathered, you will not have to pay a copay, coinsurance or deductible for the list of required preventive care services impacted by healthcare reform regulations, as long as they are obtained through an in-network provider.
When do the new requirements for preventive care benefits begin?
- If you have a non-grandfathered LifeWise individual health plan, the new preventive care requirements will become effective Sept. 1, 2011.
- If you have a non-grandfathered employer-sponsored health plan, the new preventive care requirements will become effective when your plan renews on or after Oct. 1, 2010.
* The Oregon Insurance Division has asked for clarification from the federal Department of Health and Human Services about the application of the “policy year” definition to Oregon’s fixed date individual products. Therefore, this date may be subject to change.
