New Guidelines Provide Additional Women's Preventive Care with No Cost Sharing

August 3, 2011

On August 1, 2011, the Department of Health and Human Services (HHS) released an amendment to the Interim Final Regulations for preventive care under the Patient Protection and Affordable Care Act (PPACA). The amendment applies to non-grandfathered individual insurance policies as well as non-grandfathered insured and self-insured group health plans.

The amendment provides additional guidelines for women’s preventive services. Health plans will need to cover women's preventive services, including birth control, without copayments or deductibles. The guidelines reflect the recommendations made last month by the independent Institute of Medicine.

For plan years beginning on or after August 1, 2012, non-grandfathered plans will be required to cover the following additional preventive care services for women with no cost sharing:

• Annual well-woman visits
• Screening for gestational diabetes
• HPV DNA testing for women 30 years and older
• Sexually-transmitted infection counseling
• HIV screening and counseling
• FDA-approved contraception methods and contraceptive counseling
• Breastfeeding support, supplies, and counseling

For more information on the existing PPACA preventive care guidelines, visit: http://www.healthcare.gov/center/regulations/prevention/taskforce.html

Plans may impose cost sharing on brand name preventive drugs if a generic version is available and is just as effective and safe for the patient to use. Cost sharing would not be permitted on the generic drug.

Religious Exemption

The regulations do not provide for a religious exemption. However, the regulations permit the Health Resources and Services Administration (HRSA) to establish exemptions from these guidelines for coverage of contraceptive services for group health plans of religious employers. A religious employer is defined as an organization that meets all of the following criteria:

• The promotion of religious values is the purpose of the organization
• The organization primarily employs individuals who share the religious beliefs of the organization
• The organization serves primarily people who share the religious beliefs of the organization
• The organization is a nonprofit organization as described in the Internal Revenue Code Sections
6033(a)(1) and 6033(a)(3)(A)(i) and (iii).

No religious exemption is available for individual policies; they must cover contraceptives with no cost sharing.

Next Steps

There is a comment period for this amendment that ends September 30, 2011. Cigna is currently assessing this amendment and potential client impacts.