Women’s preventive care enhancements
May 21, 2012, 3:52 pm
Filed under: National Healthcare, Women's Health

The Affordable Care Act (ACA or health care reform law) requires nongrandfathered health plans to cover evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) department of HHS.

In guidelines released August 1, 2011, HHS outlined required preventive care services for women. The guidelines require nongrandfathered individual and group health plans to include these services without cost sharing:

  • Well-woman visits
  • Screening for gestational diabetes
  • Testing for human papillomavirus (HPV)
  • Counseling for sexually transmitted infections
  • Screening and counseling for human immunodeficiency virus (HIV)
  • FDA-approved contraception methods and contraceptive counseling
  • Breastfeeding support, supplies and counseling
  • Screening and counseling for interpersonal and domestic violence

For group health plans (whether insured or ASO), these services must be provided at the first plan year on or after August 1, 2012. For individual plans, the services must be provided in new policies beginning on or after August 1, 2012, and existing policies beginning at the start of the next policy year following August 1, 2012 (generally January 1, 2013). System and market considerations may accelerate the effective date in the individual market in some states.

The guidelines require coverage of contraceptive methods “as prescribed.” This language appears to limit the coverage requirement to contraceptive methods that require a prescription; future guidance may clarify this issue. The guidelines allow plans to encourage lower-cost contraceptives by charging cost-sharing for brand-name contraceptives when a generic is available.

The initial guidance about these requirements allowed a narrowly defined group of religious employers (essentially just churches) to choose not to cover contraceptives and sterilizations as part of preventive care benefits. Many other religious groups, such as religiously affiliated hospitals and universities, will not qualify for this exemption. On February 10, 2012, the administration announced its intention to issue revised regulations. According to a White House Fact Sheet, the revised regulations will:

  • Exempt churches, other houses of worship and similar organizations from covering contraception on the basis of their religious objections.
  • Establish a one-year transition period for other religiously affiliated organizations while this policy is being implemented.

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