Executive Summary
• Federal agencies have issued rules requiring non-grandfathered health plans to cover a wide array of women's health services with no cost-sharing.
• The mandate includes coverage for contraceptive devices, subject to a "conscience clause" exempting some plans sponsored by religious organizations.
• The new rules take effect for plan years beginning after July, 2012, and therefore won't affect calendar year health plans until 2013.
• In recent months, federal authorities have also added several other new preventive care services to the list of those which non-grandfathered plans subject to healthcare reform must cover with no cost-sharing.
• Grandfathered employer health plans (both insured and self-funded) are exempt from the rules requiring coverage of certain preventive care with no cost-sharing.
What Women's Preventive Services Must Be Covered?
The women's preventive services that must be covered (without cost-sharing) by non-grandfathered plans subject to healthcare reform include:
• The mandate includes coverage for contraceptive devices, subject to a "conscience clause" exempting some plans sponsored by religious organizations.
• The new rules take effect for plan years beginning after July, 2012, and therefore won't affect calendar year health plans until 2013.
• In recent months, federal authorities have also added several other new preventive care services to the list of those which non-grandfathered plans subject to healthcare reform must cover with no cost-sharing.
• Grandfathered employer health plans (both insured and self-funded) are exempt from the rules requiring coverage of certain preventive care with no cost-sharing.
What Women's Preventive Services Must Be Covered?
The women's preventive services that must be covered (without cost-sharing) by non-grandfathered plans subject to healthcare reform include:
1. Well-woman office visits: An annual well-woman preventive care office visit for adult women to obtain the recommended preventive services.
2. Gestational diabetes screening: A screening for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes.
3. HPV DNA testing: A test every three years for women age 30 or older for high-risk human papillomavirus (HPV).
4. STI counseling, and HIV screening and counseling: Annual counseling for sexually-active women concerning HIV and sexually transmitted infections (STIs).
5. Contraception and contraceptive counseling: Access to all FDA-approved contraceptive methods, sterilization procedures, patient education and counseling.
6. Breastfeeding support, supplies, and counseling for pregnant and postpartum women: Lactation support and counseling, as well as breastfeeding equipment.
7. Domestic violence screening: Annual screening and counseling for interpersonal and domestic violence.
Contact your insurance broker or carrier for further details and how this may impact your health care coverage for employees.
