Plan Exclusions for Weight Management Services No Longer Permitted

October 18, 2016

Under the Affordable Care Act, non-grandfathered group health plans are required to provide certain preventive benefits at no cost to participants who receive these benefits in-network. One of the primary sources for preventive benefit coverage requirements is the U.S. Preventive Services Task Force (“USPSTF”). The USPSTF frequently updates its preventive benefit recommendations and covered plans must provide the benefits that they recommend. Previously, USPSTF only required plans to cover screening for obesity in adults. Recently, the Task Force expanded its recommendation to include weight management services for adults with a Body Mass Index (“BMI”) of 30kg/m2 or higher. These weight management services may include counseling sessions, both group and individual; goal setting; and lifestyle management. Plan sponsors should remove any weight management exclusions now and add weight management services to their preventive benefits coverage by the plan year that begins on or after exactly one year from the issue date of September 2016.

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