All Common Ground Healthcare Cooperative (CGHC) plans include coverage for no-cost-share preventive care benefits. The Affordable Care Act (ACA) defines a specific list of preventive care services that are covered at no cost to you when you use an in-network provider, and the services are billed appropriately. We encourage members to use these services to help maintain optimal health.
Understand Your Coverage to Maximize Your Benefits.
Deciding which services to receive is between you and your doctor. Our job is to help you understand your benefits.
Understanding the difference between “no-cost-share preventive care” (required under the ACA) and other services consider preventive by you or your doctor is important. Copayments, coinsurance, and deductibles apply to covered services that are not on the ACA defined list. Cost sharing also applies to services when the purpose is diagnostic care.
- Preventive care applies when you don’t have any history, symptoms, or other health concerns for which the testing or screening is being done.
- Diagnostic care applies when you do have a history, symptoms, or risk factors of a health concern. Tests and screenings become “diagnostic”under these circumstances because the doctor is trying to diagnose or monitor a health condition. Co-payments, coinsurance, and deductibles apply to covered diagnostic services.