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Preventative Services

OVERVIEW As a consequence of the passage of the Affordable Care Act, beginning January 1, 2012, the Writers’ Guild-Industry Health Fund began to cover preventative services at no cost to Participants (provided services are rendered in-network). You can see the details of how this works in the original Summary of Material Modifications in PDF format (see pages 5-8).

There are also detailed explanations of what the legislation requires the Health Plan to cover, separated by categories (all adults, women, and children), at the government healthcare website.

WHAT KINDS OF THINGS ARE COVERED BY PREVENTATIVE SERVICES? There are three sets of preventative services: for adults, for women, and for children.

Here are a few examples of adult preventative services:

  • Hepatitis screening (B and C)
  • Colorectal cancer screening (for adults over 50)
  • Cholesterol screening
  • Diet counseling
  • Tobacco use screening (including cessation intervention)

There are over 18 separate services covered for adults, and 14 separate vaccine protocols. The complete list can be found here.

There are over 26 preventative services for women. This is in addition to the vaccination protocols available to all adults.

Here are a few examples of preventative services available for women who are pregnant or may become pregnant:

  • Anemia screening
  • Urinary tract or other infection screening
  • Gestational diabetes screening
  • Breastfeeding comprehensive support and counseling
  • RH incompatibility screening

Other covered preventative services for women include:

  • Breast cancer genetic test counseling (BRCA)
  • Cervical cancer screening
  • Osteoporosis screening
  • Breast cancer mammography screenings

The complete list of covered services for women can be found here.

There are over 27 preventative services available for children as well as an additional 14 vaccinations.

The services for children include such things as:

  • Developmental screening
  • Autism screening
  • Lead screening
  • Vision screening

The complete list of preventative screenings can be found here.

WHAT DOES IT COST WHEN YOU USE PREVENTATIVE SERVICES? As long as the preventative services are obtained in-network, there is no cost to the Participant. It is worth noting that many of the preventative services required by the Affordable Care Act were already covered by the generous health care provisions of the Health Fund’s Wellness Benefits.

The Health Fund will apply the (free) preventive services first and any remaining Wellness Benefits (that do not constitute preventive services) will be applied toward the Health Fund’s $500 per person or $1500/per family annual Wellness Benefit. In other words, the Health Fund will make sure that the free preventative services to which you are entitled are not credited against the Wellness Program, thus helping you to maximize the benefits you have available.

When an office visit includes preventative services as part, but not all, of the overall visit, the payment will be determined by the way the physician bills the Health Fund. Also, there may be times when you are seen by your doctor for your annual physical examination, but your doctor may order several tests. Some of those tests may be considered preventive services. These tests will be paid at 100% of the network contract allowance only if in-network. Some of the tests ordered by your doctor might not be for preventive services and may be subject to any applicable deductibles, co- pays, or co-insurance. For example, if you go to a network provider for a sore throat and while there it is recommended that you have your cholesterol checked, the office visit is subject to the deductible/co-pay/coinsurance, and the cholesterol test is paid at 100%.

If you are considering preventative services as part of a visit to your healthcare provider and you are not certain exactly how much will be covered, you can contact the Health Fund for more detailed recommendations.

DON’T LET THE OPPORTUNITY PASS YOU BY Preventative services are free as long as you use an in-network provider.

While the rules governing how payment is apportioned when you visit a doctor for preventative services and something else can be complicated, the bottom line is simple: preventative services can help you avoid medical problems, and allow you to discover existing problems at an early stage where they may be easily addressable. Vaccinations are available for a host of diseases – for you and your family. Take advantage of preventative services; keep yourself and your family healthy and safe.