Recent News

August 12, 2011

Some Health Plans Must Cover Contraceptives

~ written by Char Sutak, Employee Benefits, Willis

The list of preventive care items that non-grandfathered health plans must cover with no cost sharing expanded yesterday when guidance on women’s preventive health care services was issued. The guidance includes contraceptives as one of the items that must be provided, but also includes a provision exempting certain religious organizations from the requirement. Plans are required to begin providing these women’s preventive health care services with no cost sharing no later than the plan year starting on or after August 1, 2012 (January 1, 2013, for calendar year plans).

The health care reform law included a requirement that employer-sponsored health plans cover certain preventive health care services and do so without any cost-sharing requirements for such services. The requirement became effective, for non-grandfathered plans only, at the start of the first plan year beginning on or after September 23, 2010 (January 1, 2011 for calendar-year plans). Regulations implementing this requirement and identifying the relevant preventive services, were issued in July 2010.

Instead of just listing the preventive services, the regulations referred to lists of preventive services issued by several different authorities (e.g., Centers for Disease Control and Prevention and United States Preventive Services Task Force). Because the items included on the various lists change from time to time, the regulations also provided for coverage of new items added to those lists no sooner than the first plan year starting at least one year after the date of an addition. When the regulations were issued, one of the lists – the one regarding women’s preventive health care services – was under development. (More specifically, the regulations refer to that list as evidence-informed preventive care and screenings for women as provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.)

New List Includes Contraceptives

The list of women’s preventive health care services includes contraceptive methods and counseling as one of several items that must be covered with no cost sharing, subject to an exception for certain religious organizations’ plans. The agencies that issued last July’s regulations also issued an amendment allowing for the exception. As provided in the regulations, the items on the new list need not be covered by any plan until the plan year starting at least one year after the addition of these items. That means this change will be effective for plan years starting on or after August 1, 2012 (January 1, 2013 for calendar year plans). Willis’s National Legal & Research Group (NLRG) is reviewing the newly issued guidance and will provide analysis and suggested compliance strategies in a future publication.