Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications


On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the Affordable Care Act (ACA) and mental health parity disclosure, adding to the existing list of 28 previous editions of FAQs on the implementation of ACA.

Section 2713 of the ACA requires non-grandfathered group health plans and health insurance offered in individual or group markets to cover preventive care without cost sharing, including 1) evidence-based services with a rating of “A” or “B” in the current recommendations of the U.S. Preventive Services Task Force (USPSTF); 2) immunizations for routine use in children, adolescents and adults that are recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC); 3) evidence-informed preventive care and screenings for infants, children and adolescents from comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and 4) evidence-informed preventive care and screening for women from comprehensive guidelines supported by HRSA, if not included in certain recommendations of the USPSTF.

In addition, under Code Section 9802 of the Internal Revenue Code, group health plans and health insurance issuers in individual or group markets are prohibited from discriminating against individuals when establishing eligibility, benefits or premiums based on a health factor. However, group health plans and issuers in individual or group markets may allow premium discounts, rebates or modification of cost sharing for participation in wellness programs. Finally, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) amended the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code to increase parity between mental health and substance use disorder (MH/SUD) benefits and medical/surgical benefits.

The most recent government FAQs address the following issues:

Coverage of Preventive Services

Lactation Counseling

Other Preventive Services

Religious Accommodation

Wellness Programs

MHPAEA and Disclosure

Next Steps

Employers should review the design of their health plan and disclosure documents to ensure that they comply with the requirements outlined above. Employers should also coordinate with their service providers who may assist in preparing these disclosures to ensure this information is being included in the documents provided to participants.

Sarah Raaii also contributed to this article.


© 2025 McDermott Will & Emery
National Law Review, Volume V, Number 307