Update regarding annual wellness visits for ACA-compliant health plans

Empire BlueCross BlueShield (“Empire”) covers annual wellness visits and well-woman visits at 100% with no member cost-sharing when provided by in-network providers for members that have ACA-compliant plans. Beginning January 1, 2022, Empire will encourage some ACA-compliant individual and small group plan members to schedule annual wellness visits or well-woman visits with their physician within the first 90 days of the plan renewal.

 

Some providers currently require patients to schedule wellness visits or well-woman visits at least one year past their most recent visit. This practice helps ensure a patient does not exceed more than one wellness visit per calendar year. Beginning January 1, 2022, providers can perform the annual wellness visit or well-woman visit for these members, even if it has been less than one year since the last wellness visit. The claim for the wellness visit or well-woman visit will be processed as a preventive care service covered at 100% as long as its billed accordingly.  

 

Please note, this benefit may not apply to all health plans. Providers should continue to verify eligibility and benefits for all members prior to providing services or receiving member copayments, deductibles, or coinsurance.

 

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