Final Contraceptive Regulations for Religious Organizations Issued
July 8, 2013
On June 28, 2013, the Departments of Health and Human Services, Labor and Treasury issued final regulations about contraceptive coverage for religious organizations that object to covering contraceptive services.
The final rule changes the effective date from plan years beginning on or after August 1, 2013 to plan years beginning on or after January 1, 2014. See below for more details.
Contraceptive Coverage – Highlights of the Final Rule
What Stayed the Same
- Group health plans sponsored by religious employers such as churches do not have to cover contraceptive services.
- Group health plans sponsored by religious non-profit organizations such as hospitals, schools, universities and charities that object to offering contraceptive coverage do not have to provide contraceptive coverage. Instead, the plan’s insurer or third-party administrator (TPA) is required to provide or arrange for contraceptive coverage separately from the group health plan at no cost to the organization or plan participants.
- Group health plans sponsored by for-profit, secular employers are required to cover contraceptives, even if they object to contraceptives for religious reasons.
- The final regulation is effective for plan years beginning on or after January 1, 2014. The original effective date was August 1, 2013. Religious non-profit organizations that have certified under existing temporary safe harbor provisions that they do not want to cover contraceptives can exclude contraceptive coverage for plan years beginning between August 1 and December 31, 2013.
- Religious non-profit organizations must self-certify that they do not want to cover contraceptives only one time – not every year. The certification must be completed before the beginning of the first plan year for which it will be effective. Employers must present the certificate to any insurer or TPA they contract with.
- For self-funded plans, the employer must self-certify to its TPA that it will not act as plan administrator for contraceptive services.
- For insured plans, insurers must exclude contraceptive coverage from the employer’s group plan and pay for contraceptive services separately from the employer's plan. However, insurers will not be required to issue individual insurance policies to cover contraceptives. Instead, the insurer will pay for all FDA-approved contraceptive services for covered employees and their dependents without charging any premium or fee to the employer, or any cost sharing such as copays or coinsurance to plan participants.
- For self-funded plans, the final regulations make the TPA an ERISA plan administrator and claims administrator for the purpose of providing payments for contraceptive services. The administrator can pay for the contraceptive services or contract with an insurer to provide the benefits. The cost of contraceptive services provided to self-insured employers can be reimbursed through adjustments to the Federally-Facilitated Exchange (FFE) user fees paid by TPAs or insurers who pay for contraceptive coverage.
Plan Participant Notification
The TPA or insurer must notify plan participants that separate contraceptive coverage is available. This notice must be provided separately from, but at the same time as, when employees receive enrollment materials for their group health plan.
Revised Definition of Religious Employers
The final regulation includes a revised definition of religious employers effective August 1, 2013. The new definition eliminates the requirement that religious employers have promotion of faith as their sole purpose and only hire and serve people of their faith. It requires only that religious employers be churches or houses of worship as defined by the Internal Revenue Code.
This change was made to clarify that a church or house of worship does not have to offer contraceptive coverage, even if it provides charitable social services to or employs people of different religious faiths.
Student Health Plans, Multiple Employer Groups and State Laws
- Student health plans are subject to the same rules as employer plans.
- For multiple employers that offer coverage through a single group health plan, each employer must independently meet the requirements for the religious employer exemption or self-certify that they do not want to cover contraceptives.
- Insured plans must comply with any state laws requiring contraceptive coverage under the group health plan.
Additional Documents Provided with the Regulation
The following documents were provided with the final regulation:
- A form religious non-profit organizations can use to self-certify that they do not want to provide contraceptive coverage
- A model notice insurers and TPAs can use to communicate the availability of separate contraceptive benefits to plan participants
- A fact sheet that provides an overview of the key provisions included in the regulation
- Technical guidance on the extension of the safe harbor for religious non-profit organizations through December 31, 2013
We encourage you to bookmark Cigna’s health care reform website, InformedOnReform.com.