Agencies Issue Interim Final Rule Expanding Coverage Requirements for Women's Preventive Services

stethoscope and apple.jpgThe Department of Labor’s Employee Benefits Security Administration (EBSA) along with the Departments of the Treasury and Health and Human Services have issued an interim final rule (pdf) that expands the types of women’s health preventive services that must be covered without any cost-sharing by non-grandfathered health plans, and expressly affirms that state laws that impose requirements on health insurance issuers that are stricter than the requirements imposed by the Affordable Care Act are not preempted.

The Affordable Care Act requires that non-grandfathered group health plans and health insurance issuers offering group or individual health insurance coverage provide benefits for and prohibit the imposition of cost-sharing with respect to a number of specified preventive health services, including those applicable to women’s health. The Departments previously issued interim final regulations implementing this mandate on July 19, 2010. The latest regulations adopt guidelines developed by the Health Resources and Services Administration (HRSA), an agency charged with developing such comprehensive guidelines for preventive care and screenings with respect to women.

As outlined in a fact sheet, new private health plans must include the following services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012:

  • well-woman visits;
  • screening for gestational diabetes;
  • human papillomavirus (HPV) DNA testing for women 30 years and older;
  • sexually-transmitted infection counseling;
  • human immunodeficiency virus (HIV) screening and counseling;
  • FDA-approved contraception methods and contraceptive counseling;
  • breastfeeding support, supplies, and counseling; and
  • domestic violence screening and counseling.

Plans are still permitted to use reasonable medical management to help define the nature of the covered service. For example, plans may continue to charge cost-sharing for branded drugs if a comparable generic version is available.

Notably, with respect to including contraceptive coverage, the interim rule includes a religious accommodation allowing religion-based employers to be exempt from this requirement if they so choose. The amended regulations specify that, for purposes of this policy, a religious employer is one that: (1) has the inculcation 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. According to a press release, “this regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.”

The agencies invite comment on this exemption policy. Such comments are due within 60 days of the rule’s publication in the Federal Register, which is scheduled for August 3, 2011. Comments must be identified by the regulatory identification number: RIN 1210-AB44, and be submitted through the federal eRulemaking portal, via email: E-OHPSCA2713.EBSA@dol.gov, or by regulator mail or hand-delivery to: Office of Health Plan Standards and Compliance Assistance, Employee Benefits Security Administration, Room N-5653, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210, Attention: RIN 1210-AB44.

Photo credit: ODonnell Photograf

Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.