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Guidelines Adopted on Required Coverage of Preventive Health Services for Women by Non-Grandfathered Group Health Plans

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Lauren B. Dunn
Foster Swift Employment, Labor & Benefits Quarterly
Fall 2011

The Department of Health and Human Services ("HHS") has announced that the Health Resources Services Administration ("HRSA") has adopted guidelines on the required coverage of preventive health services for women by non-grandfathered group health plans. These guidelines were developed by the Institute of Medicine.

Effective for the first plan year that begins on or after August 1, 2012 (January 1, 2013 for a calendar year plan), a non-grandfathered group health plan is required to provide certain preventive health services for women. Coverage without cost-sharing (i.e., no deductible, co-payments or co-insurance) for these services is required when the services are delivered by an in-network provider. Most notably, this requirement includes providing coverage for FDA-approved contraception and counseling. Other preventive services that must be covered with no cost sharing include screening for gestational diabetes, HPV testing as part of screening for cervical cancer for women age 30 and older, annual counseling on sexually transmitted infections, annual counseling and screening for HIV infection, lactation counseling and breastfeeding equipment rental, screening and counseling for interpersonal and domestic violence and annual well-woman preventive care visits to obtain recommended preventive services.

In addition to adopting the foregoing guidelines, the Department of Labor, HHS, and the Treasury released an amendment to the interim final regulations that implement the Patient Protection and Affordable Care Act. Effective August 1, 2011, the amendment allows the HRSA discretion to exempt certain religious employers that offer health insurance to their employees from the requirement to cover contraceptive services. A "religious employer" is an employer that (1) has the teaching 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 section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code.

Please contact your Foster Swift employee benefits professional if you have any questions regarding this recent development.