Back to Insights and Updates for ProvidersApril 2023

Preventive services coverage reminders and resources

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As a reminder, in accordance with provisions of the Patient Protection and Affordable Care Act (PPACA), Harvard Pilgrim Health Care and Tufts Health Plan members are entitled to receive full coverage for preventive care services, with no cost-sharing responsibility, when these services are rendered by an in-network provider.

Members may still be required to pay a copayment, deductible, or other coinsurance for preventive services administered by an out-of-network provider, or for non-preventive services received in conjunction with a preventive service visit.

Where to find PPACA and preventive services information
Harvard Pilgrim’s Patient Protection and Affordable Care Act (Federal Health Care Reform) policy — which you can find in the Member Care section of the Commercial Provider Manual — as well as Tufts Health Plan’s Preventive Services Policy, outline coverage and services for preventive care, procedure and diagnosis coding information related to preventive services and immunizations, and more.

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