Preventive Services Final Rules
By Danielle Capilla
Chief Compliance Officer
United Benefit Advisors
Federal agencies released final regulations on the preventive services mandate of the Patient Protection and Affordable Care Act (ACA) that requires non-grandfathered group health plans to provide coverage without cost-sharing for specific preventive services, which for women include contraceptive services.
After pushback from religious employers, interim final regulations, objections from certain employers with religious objections and the subsequent Supreme Court decision in Burwell v. Hobby Lobby, proposed regulations, further final regulations, additional interim final regulations, and another set of proposed regulations, the 2015 Final Rules (applicable for plan years beginning on or after September 14, 2015) provide the following:
- Formalizes prior guidance requiring a plan to cover out-of-network services without cost sharing if the plan does not have an in-network provider who can provide a required preventive service.
- Provides for midyear plan changes if a recommended preventive service is downgraded (by task force or advisory body) to a "D" rating or is subject to a safety recall or other significant safety concern.
- Provides contraceptive coverage accommodations for eligible organizations.
For all the details related to out of network coverage, additional preventive service coverage, timing requirements, contraception, accommodations and important healthcare.gov links, download UBA’s free PPACA Advisor: “Preventive Services Final Rules”.