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ACA Preventive Services


The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive services at 100% of the eligible charge not subject to deductible when rendered by in-network providers. HMSA’s ACA Preventive Health Guideline policies are listed below. Please review the appropriate policy before providing preventive services to your patients so you can discuss with them if the services will be covered. For your convenience, a link to the billing and coding guidelines is included at the end of each policy.


We also have a list of plans which have implemented ACA requirements on the Coverage Codes for Affordable Care Act (ACA) page.



Document Name: Document Number:
Preventive Health Guidelines - Men
Preventive Health Guidelines - Newborns and Children
Preventive Health Guidelines - Prenatal Care pel.aa.OBG.501
Preventive Health Services - Women



Files that are in PDF format can be viewed using the free Adobe Reader or another PDF-reader application.

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