Must group health plans cover obesity screening?


Your benefits department is reviewing the company's non-grandfathered group health plan and considering the possibility of adding a general exclusion for weight management services for adult obesity. Is this permissible?


No. Consistent with Public Health Service Act (PHSA) Sec. 2713, its implementing regulations, and current U.S. Preventive Services Task Force (USPSTF) recommendations, non-grandfathered plans and issuers must cover, without cost sharing, screening for obesity in adults.

In addition to such screening, the USPSTF currently recommends, for adult patients with a body mass index (BMI) of 30 kg/m2 or higher, intensive, multicomponent behavioral interventions for weight management. The recommendation specifies that intensive, multicomponent behavioral interventions include, for example, the following:

  • Group and individual sessions of high intensity (12 to 26 sessions in a year);
  • Behavioral management activities, such as weight-loss goals;
  • Improving diet or nutrition and increasing physical activity;
  • Addressing barriers to change;
  • Self-monitoring; and
  • Strategizing how to maintain lifestyle changes.

While plans and issuers may use reasonable medical management techniques to determine the frequency, method, treatment, or setting for a recommended preventive service, to the extent not specified in the recommendation or guideline regarding that preventive service, plans are not permitted to impose general exclusions that would encompass recommended preventive services.

Additionally, with respect to individual and small group market issuers subject to the essential health benefits (EHB) requirements under Patient Protection and Affordable Care Act (ACA) Sec. 1302(b) and PHSA Sec. 2707(a), to the extent the applicable EHB-benchmark plan does not include coverage of the required preventive services (including obesity screening and counseling), the issuer must nonetheless provide coverage for such preventive services consistent with PHSA Sec. 2713 and its implementing regulations, and with the regulation implementing the EHB requirements at 45 CFR 156.115(a)(4).

Source: FAQs About Affordable Care Act Implementation (Part XXIX) and Mental Health Parity Implementation, October 23, 2015;

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