Reminders and Updates

Preventive Benefit Updates for January 1, 2024

December 7, 2023

New state and federal healthcare rules take effect on January 1, 2024. Here’s a roundup of the key changes impacting preventive care benefits:

CDC recommendations

The US Centers for Disease Control and Prevention (CDC) approved two mRNA vaccines for COVID-19, from Pfizer and Moderna, for those 6 months and older. The updated Novavax vaccine was recently approved for those ages 12 and up. Under the terms of the Affordable Care Act, LifeWise members and all people with commercial health insurance plans through the government or their employer can receive vaccines at no cost.

The CDC also approved a Respiratory Syncytial Virus (RSV) vaccine. In line with their recommendation, RSV vaccinations will be covered in full for LifeWise members who are adults ages 60 and older, pregnant women, infants younger than 8 months, and infants 8 months to 19 months at increased risk.

Washington state benefit mandates

The Washington State Legislature passed a law (HB1222) this year that requires fully insured non-grandfathered group plans, excluding small group, and SEBB plans to cover hearing instruments, including bone conduction hearing devices, starting January 1, 2024. This coverage also includes initial assessment, fitting, adjustment, auditory training, and ear molds as necessary to maintain optimal fit. (Note: It is important for providers to indicate which ear their billing codes are for as the bill has a requirement to allow $3,000.00 per ear every 36 months.)

New coverage is also in place for breast health examinations. Washington State mandate SB5396 requires that for non-grandfathered health plans issued or renewed on or after Jan 1, 2024, a carrier may not impose cost sharing for supplemental or diagnostic breast examinations. If the health plan is a qualified high deductible, it will be subject to the minimum IRS deductible, then 0% coinsurance.

Preventive benefits for abortion services will be changing for members on fully insured group, individual, and SEBB plans. Starting in 2024, Washington mandate SB 5242 requires abortion to be covered in full with no cost-sharing. If the health plan is a qualified high deductible, it will be subject to the minimum IRS deductible, then 0% coinsurance.

U.S. Preventive Services Task Force (USPSTF)

LifeWise rolled out USPSTF updates to our health plans on July 1 of this year, or as groups renew. Many plans renew January 1, making it a great time to review the latest USPSTF updates.

Visit our medical policy and coding updates page for more information about preventive coverage and benefits. Resources will be updated on/after effective dates, as applicable.