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Agencies Adopt Additional Guidelines for Women’s Preventive Services

The Affordable Care Act (“ACA”) requires group health plans (other than plans that are “grandfathered”) to cover a list of preventive health services.  Earlier this month, the three agencies charged with administering the ACA issued additional rules describing women’s preventive services that must also be covered.  Like the services listed in earlier agency guidance, these women’s preventive services must be covered on a first-dollar basis, with no cost-sharing requirement, by “non-grandfathered” group health plans.  This article briefly summarizes the new rules.

Covered benefits include well-woman visits, certain breastfeeding equipment, contraceptive methods and counseling, screening for gestational diabetes, and screening and counseling for domestic violence.  Generally speaking, the new rules apply to all non-grandfathered plans and are effective for plan years beginning on or after August 1, 2012 (i.e., January 1, 2013, for calendar-year plans).  However, the agencies have already amended the rules to allow religious employers to choose whether to cover contraceptive services.

Guidelines for Women’s Preventive Services

The following chart summarizes the guidance issued this month by the Department of Health and Human Services (“HHS”) on the additional rules for women’s preventive services.

Type of Preventive Service HHS Guideline for Health Insurance Coverage Frequency

Well-woman visits

Annual visit for adult women to obtain age and developmentally appropriate preventive services, including preconception and prenatal care.  Where appropriate, this visit should include other preventive services listed in the HHS guidelines, as well as services described in previous guidance.

Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.

Screening for gestational diabetes

Screening for gestational diabetes.

In pregnant women between 24 and 28 weeks of gestation, and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. 

Human papillomavirus testing

High-risk human papillomavirus DNA testing in women with normal cytology results.

Screening should begin at 30 years of age and should occur no more frequently than every 3 years.

Counseling for sexually transmitted infections

Counseling on sexually transmitted infections for all sexually active women.

Annual.

Counseling and screening for human immune-deficiency virus

Counseling and screening for human immune-deficiency virus infection for all sexually active women.

Annual

Contraceptive methods and counseling

All FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

As prescribed.

Breastfeeding support, supplies, and counseling

Comprehensive lactation support and counseling by a trained provider, during pregnancy and/or in the postpartum period, plus costs for renting breastfeeding equipment.

In conjunction with each birth.

Screening and counseling for interpersonal and domestic violence

Screening and counseling for interpersonal and domestic violence.

Annual.


Exemption for Religious Employers

Under the amended regulations, if a religious employer objects to contraception on religious grounds, its non-grandfathered group health plan (whether insured or self-funded) need not cover contraceptive services.  Such plans must, however, offer all of the other women’s preventive services listed in the chart, above.

The faith-based exemption is consistent with contraception coverage mandates under state laws, which typically exempt religious employers.  To qualify for the exemption, a religious employer must satisfy three criteria:

  • its purpose must be to instill religious values;
  • it must primarily employ and serve persons who share its religious tenets; and
  • it must satisfy the Internal Revenue Code filing exemptions for religious entities.

The exemption applies only to group health plans sponsored by certain religious employers and any group health insurance offered in connection with such plans.  Accordingly, health insurance issuers in the individual market are not covered under the exemption.