Under the Expanded Patient Protection and Affordable Care Act (PPACA), mandated benefits include:

---

Women’s Health:

Nutritional counseling for Obesity Prevention in midlife women, ages 40 to 60 years old, with normal body mass index (BMI) and overweight BMI.

• Explanation: Women’s Preventive Services Initiative recommends counseling midlife women with normal or overweight BMI (18.5-29.9 kg/m2) to maintain weight or limit weight gain for preventing obesity. Counseling may include individualized discussion of healthy eating and physical activity.

---

Aspirin No Longer Recommended:

Taking a small daily dose of aspirin to reduce the risk of stroke and heart attack is no longer recommended for healthy people between the ages 50 to 59.

• Explanation: United States Preventive Services Task Force (USPSTF) update removed B rating grade and lowered the recommendation to a C grade, which does not require a zero-cost share under the preventive Affordable Care Act mandate. The midyear 2022 update notified members via a footnote that the benefit would no longer be effective beginning January 1, 2023.

---

Adult Diabetes Prevention Program (DPP):

Applies to adults without a diagnosis of diabetes (does not include a history of gestational diabetes), who have the following conditions:

• Overweight or obese (determined by BMI),
• Fasting blood glucose of 100-125 mg/dl, or
• HGBA1c of 5.7% to 6.4%, or
• Impaired Glucose Tolerance Test of 140-199mg/dl.

Enrollment approved for certain select Centers for Disease Control and Prevention (CDC)-recognized, lifestyle-change DPPs for weight loss.

---

Labs:

Only PPACA federal mandates and NY state mandates for labs with no cost share are included in the preventive schedule. For example, a screening PAP smear lab or a blood glucose lab ordered when there are no symptoms.

Even if ordered as part of a preventive visit, labs done related to a medical diagnosis will have cost sharing per medical benefits. For example, a medical diagnosis is needed such as fatigue, for a complete blood count (CBC), metabolic panel, thyroid testing, vitamin levels, and urinalysis. Diagnostic labs ordered without a medical diagnosis as part of a preventive office visit will be denied. For more information, see the FAQs posted here .