For New and Non-Grandfathered Plans
Women’s Preventative Services: The Health Resources and Services Administration (“HRSA”) has issued new guidelines on required coverage of women’s preventive services which must be provided without cost sharing (deductibles, co-payments, co-insurance, etc.) if delivered by an in-network provider. These requirements are effective for plans years beginning on or after August 1, 2012 (January 1, 2013 for calendar year plans).
The guidelines fall under the Patient Protection and Affordable Care Act (PPACA) requirements for non-grandfathered plans to cover certain preventive services with no in-network cost-sharing (See Preventive Care Coverage Requirements). Under the PPACA, women’s preventive health care services, such as mammograms, screenings for cervical cancer, and other preventive services are already included in the mandate applicable to non-grandfathered health plans requiring the provision of recommended preventive care coverage on a first-dollar basis.
The new guidelines now add the following preventive services to this list:
- well-woman visits;
- screening for gestational diabetes;
- human papillomavirus (HPV) DNA testing for women 30 years and older;
- sexually-transmitted infection counseling;
- human immunodeficiency virus (HIV) screening and counseling;
- FDA-approved contraception methods and contraceptive counseling (subject to an exemption for religious employers);
- breastfeeding support, supplies, and counseling; and
- domestic violence screening and counseling.
Alongside the women’s prevention guidelines, the Department of Health and Human Services issued an amendment to the interim final regulations related to the preventive care mandate. This amendment exempts “religious employers” from the requirement to cover contraception methods and counseling if providing such coverage is inconsistent with its religious tenets. For purposes of this exemption, a religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) (referring to churches, their integrated auxiliaries, and conventions or associations of churches).
For more information, see the HHS news release or the HRSA Guidelines.