• Non-Grandfathered Plans Must Offer First Dollar Contraceptive Coverage
  • September 16, 2011 | Author: Mary V. Bauman
  • Law Firm: Miller Johnson - Grand Rapids Office
  • One of the requirements for non-grandfathered group health plans under Health Care Reform is to provide coverage for certain in-network preventive services at no additional cost to the participant (i.e., no copay, coinsurance or similar cost-sharing). For more information, see our July 21, 2010 article Group Health Plans Required to Cover In-Network Preventive Care at No Additional Cost."

    Guidance issued last year indicated that the list of required preventive care items and services will change periodically and that plans need time to implement the revisions. As a result, a non-grandfathered plan is only required to provide 100% coverage for a particular preventive care item or service for plan years beginning on or after the date that is one year from the date the item or service is added to the list of required preventive care items and services.

    On August 1, 2011 the U. S. Department of Health and Human Services (HHS) issued new guidelines for women's preventive care services. The list includes annual physicals, screenings for gestational diabetes and breastfeeding support and supplies. Probably the most significant new requirement is coverage for all FDA-approved contraceptive methods, sterilization procedures and patient education/counseling for women with reproductive capacity. However, abortifacient drugs (i.e., drugs that induce abortion) are not required to be covered. As a result of the new guidance, non-grandfathered employer group health plans must offer first dollar contraceptive coverage (including coverage for oral contraceptives and contraceptive devices) as of the first day of the first plan year beginning on or after August 1, 2012.

    At the same time this guidance was issued, an interim final rule was published which gives the Health Resources and Services Administration the authority to grant an exemption to the mandate to provide contraceptive coverage for certain religious employers. However, the definition of a religious employer for purposes of the exemption is narrow. It is a non-profit church or related organization that has the inculcation of religious values as its purpose, and where the organization primarily employs persons who share its religious tenants and the organization primarily serves persons who share its religious tenants.