The U.S. Department of Health and Human Services (HHS) on Aug. 1, 2011, issued guidelines requiring nongrandfathered U.S. health insurance plans to cover women’s preventive services, including contraception, without charging a co-payment, co-insurance or a deductible, beginning on Jan. 1, 2013, for most plans.
Policy analysts expect that the cost for these services will result in a slight additional increase to premiums paid by employers and employees.
In 2010, the Obama administration released new insurance market rules under the Patient Protection and Affordable Care Act (PPACA) requiring all new private health plans to cover "evidence-based" preventive services, including mammograms, colonoscopies, blood pressure checks and childhood immunizations without charging a co-pay, deductible or co-insurance. In addition, the PPACA required that recommended preventive services for people on Medicare be offered at no cost to the consumer.
Under the new HHS guidelines, preventive services that nongrandfathered insurance plans must provide with no consumer cost-sharing include:
• Food and Drug Administration (FDA)-approved contraception methods, including birth control pills.
• Contraceptive counseling.
• Breastfeeding support, supplies and counseling.
• "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.
• Domestic violence screening and counseling.
New health plans will need to include these services without cost-sharing for plan years beginning after July 31, 2012 (Jan. 1, 2013, for calendar-year plans).
The rules governing coverage of preventive services, which allow plans to use reasonable medical management to help define the nature of the covered service, apply to women’s preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.
Religious Institutions Exempted
In addition, the administration released an amendment to the interim final regulations on preventative health services under the PPACA. The amendment allows religious institutions that offer insurance to their employees to choose whether or not to cover contraception services and is modeled on the most common accommodation for churches available in the majority of the 28 states that require insurance companies to cover contraception.
Stephen Miller, CEBS, is an online editor/manager for SHRM.
What is the preventive services provision under PPACA and what plans must comply?, SHRM HR Q&As, April 2011
New Rules for Preventive Care, HR Magazine, November 2010
Ambiguity on Preventive Care Regulations Threatens to Increase Costs, Group Contends, SHRM Online Benefits Discipline, September 2010
Administration Issues Regulations on First-Dollar Preventive Care, SHRM Online Benefits Discipline, July 2010
SHRM Online Benefits DisciplineSHRM Online Health Care Reform Resource Page