Wednesday, October 23, 2019

New Guidelines Require Plans to Fully Cover Birth Control, Other Preventive Services

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The Department of Health and Human Services (HHS) has posted new guidelines stemming from the health care reform law that will have a major impact on many employer-sponsored plans' coverage of women's preventive services.

The HHS guidance under the Patient Protection and Affordable Care Act (PPACA) will require group plans to cover a number of women's health services, including birth control, with no copay or deductible, according to a report.

According to the law firm of Vorys, Sater, Seymour and Pease LLP, covered services include:

  • Contraception medicine, devices and counseling
  • Well-woman visits
  • Screening for several diseases and conditions, including gestational diabetes and human papillomavirus (HPV)
  • Breastfeeding support and supplies, such as breast pump rental
  • Counseling for those with sexually transmitted diseases
  • Counseling for those suffering from domestic violence

The plan will take effect for all nongrandfathered group plans for plan years as of Aug. 1, 2012 (Jan. 1, 2013, for calendar year plans), although some religious organizations will not be forced to cover contraceptives, according to a Business Insurance report.

While a number of health advocates praised the decision as a smart way to curb long-term health care costs, many religious and business leaders criticized the move. The Family Research Council noted the decision "undermines the conscience rights of many Americans," while Karen Ignagni, president of America's Health Insurance Plans, said the decision might actually end up costing consumers more. Ignagni said the changes "broaden the scope of mandated preventive services beyond existing evidence-based guidelines . . . and encourage consumers to obtain a prescription for routine supplies that are currently purchased over-the-counter," CNN reports.

Health Exchanges
Prior to the decision on women's preventive services, HHS also released its first solid guidance on the formation of state health care exchanges under PPACA. According to a Kaiser Health News report, the guidelines will allow states some flexibility in how they set up the exchanges, which will allow individuals and small businesses to compare and purchase health insurance starting in 2014.

HHS officials said the state exchanges will be required to post information about a plan's price and quality, offer standardized plans and hold to an annual open enrollment period. However, states will not be required to negotiate with insurers over price or plan offerings.


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