employers offered their workers a choice of more than one plan, examination of the rates of coverage of clinical preventive services in the employer’s primary plans provides the best summary of the ranges of rates of coverage for different services: 75 percent covered physical examinations, 74 percent covered gynecological examinations, 57 percent covered cholesterol screenings, and only 37 percent covered screening for Chlamydia infection.

For women, primary employer-based health plans covered breast cancer and cervical cancer screening at rates of 80 and 79 percent, respectively. Lifestyle modification services were covered at much lower rates, with nutritional counseling covered by 17 percent of primary plans, weight loss and management counseling was covered by 15 percent, physical activity counseling was covered by 13 percent, alcohol problem prevention was covered by 18 percent, and any kind of tobacco cessation service was covered by 20 percent.

Approximately half of all large employers required that their plans cover clinical preventive services, whereas only 17 percent of small employers had the same requirement. Small employers were also less likely to offer coverage of clinical preventive services and lifestyle modification services, although the differences were not large.

Large employers were far more likely than small employers to offer financial incentives to employees to use clinical preventive services. However, small employers offered flexible scheduling or time off to access preventive services much more often than large employers did. Lifestyle modification services, such as physical activity counseling and weight loss management, were covered the least often, regardless of employer size.

The National Business Group on Health conducted a comprehensive analysis and synthesis of a wide range of clinical preventive services and their impacts on disease prevention and early detection of health conditions and disease according to both health and economic measures (NBGH, 2009). On the basis of their analyses, they compiled a purchaser’s guide that recommends 46 clinical preventive services that should be included in employer health benefit plans. Benefits directly relevant to women are summarized in Box 3-1.

Individual Insurance Plans

As with the small- and large-group insurance markets, the individual insurance market appears to have considerable variability in coverage of preventive services. In a 2006–2007 survey of individual insurance plans conducted by American’s Health Insurance Plans, the trade association for health insurers in the United States (AHIP, 2007), coverage levels were found to vary considerably by type of plan, with all HMO plans responding to the survey indicating that they covered physical examinations for adults, annual visits to an obstetrician-gynecologist, and cancer screening; but far

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