New
FAQ’s on Birth Control Coverage
This week the Departments of Health and Human Services (HHS),
Labor, and Treasury issued frequently asked questions (FAQs) to help
insurance companies better understand the scope of coverage that is required
(including contraceptive care) under the Affordable Care Act (ACA) and to help
people better the ACA and benefit from it as intended.
This guidance follows recent Kaiser Family Foundation and National Women’s Law Center research that
reported variation in how the ACA contraceptive coverage provisions were being
interpreted and implemented by health plans.
Some main points of interest:
- All non-grandfathered plans and
insurers must cover, without cost sharing, at least one form of
contraception within each of the 18 methods of contraception that the FDA
has identified for women.
- If an item or service is not
covered but is determined medically necessary by the woman’s attending
provider, there must be an easily accessible process for the woman to get
that item or service;
- If an insurer covers dependent
children, recommended preventive services for women (such as preconception
and prenatal care) must be covered for the dependent children as well
(i.e., not just the parent(s) on the plan); and
- Clarifies that insurance
companies may still use reasonable medical management techniques within
each of the methods of contraception (there are currently 18 identified by
the FDA for women). For example, a plan can discourage the use of
brand name over generic pharmacy items through cost sharing.
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