Not yet a Member?
HR Magazine is highlighting the next generation of HR leaders.
Is your employee handbook ready for the New Year? With SHRM’s Employee Handbook Builder get peace of mind that your handbook is up-to-date.
30+ HR education programs, including 4 NEW programs on hot topics, are available for registration.
Join us in Chicago for the latest trends and technology in talent management, and what to expect in the future.
With 2013 around the corner, one new requirement that will be in effect on January 1 for calendar-year nongrandfathered group health plans is the coverage of certain women’s preventive services without cost-sharing. The coverage requirement is effective for plan years beginning on or after Aug. 1, 2012, and does not apply to grandfathered group health plans.
The guidelines on women’s preventive services require plans to provide coverage for the following types of preventive services without co-payments or other cost-sharing:
information about each type of service is available at the HHS website.
Out of Network Providers
The requirement to cover the preventive services without cost-sharing does not apply to services that are performed out-of-network; if a participant receives the preventive services at an out-of-network provider, cost-sharing can be imposed.
In addition, the agencies have given plans allowance to use “reasonable medical management techniques” to determine the frequency, method, treatment, or setting for the preventive services, to the extent that those items are not covered in the preventive-services guidelines.
Open questions remain regarding the coverage of women’s preventive services—for example, what type of breastfeeding supplies are eligible to be covered? Plan sponsors should continue to watch for guidance and should work with their insurers and administrators on implementing the new preventive requirements.
Jessica Faith is an associate in the ERISA, benefits and executive compensation practice at law firm
Faegre Baker Daniels.
© 2011 Faegre Baker Daniels LLP. All rights reserved.
This article should not be construed as legal advice.
Major Health Care Reform Deadlines Loom,
SHRM Online Legal Issues, October 2012
SHRM Online Health Care Reform Resource Page
Keep up with the latest news. Sign up for SHRM’s free
Compensation & Benefits e-newsletter
You have successfully saved this page as a bookmark.
Please confirm that you want to proceed with deleting bookmark.
You have successfully removed bookmark.
Please log in as a SHRM member before saving bookmarks.
Your session has expired. Please log in again before saving bookmarks.
Please purchase a SHRM membership before saving bookmarks.
An error has occurred
Recommended for you
Choose from dozens of free webcasts on the most timely HR topics.
SHRM’s HR Vendor Directory contains over 3,200 companies