Preventive Care Services
Note: On Dec. 15, 2017, a Pennsylvania federal court temporarily blocked the Interim final rules (IFRs) issued Oct. 6, 2017 to expand the exemption for employers to not cover contraceptive services under their sponsored group health plans. Since the preliminary injunction was issued by a federal court, the new IFRs cannot be enforced in any state unless or until it is removed. The injunction maintains the status quo and rules in place before Oct. 6. Please see our news alert for more details.
Almost all group health plans must cover in-network preventive services and immunizations without cost sharing (e.g., deductibles, coinsurance and copayments) or annual limits.
Preventive care services and immunizations include:
- Recommended evidence-based preventive services from the United States Preventive Services Task Force with a rating of A or B
- Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
- Preventive care guidelines developed by the Health Resources and Services Administration and the American Academy of Pediatrics
- Women’s preventive services, including well-woman visits, support for breastfeeding equipment, contraception and domestic violence screening (certain group health plan sponsors may be exempt from covering contraceptive services, see below)
Contraceptive coverage exemption rules:
Rules finalized under the ACA offer accommodation for eligible organizations that object to covering contraceptive services. Only religious employers – churches or houses of worship as defined by the Internal Revenue Code – can qualify for the exemption. Under the ACA rules, other eligible employers who objected to covering contraceptives on religious grounds were required to self-certify with their insurance carrier or third-party administrator (TPA) or file a notice with the Department of Health and Human Services (HHS). This process placed the responsibility of covering contraceptive services on the insurance carrier or TPA, and ensured the customer/individual policy holder had no cost share expenses for such services.
Interim final rules (IFRs) issued on October 6, 2017 by multiple federal agencies expand exemption eligibility for more employers. Effective immediately, employers may exclude coverage for contraceptive services based on both religious and moral objections. In addition, employers are no longer required to self-certify their objections with their insurance carrier or HHS. Because this accommodation is now optional, it is possible that costs for contraceptive services may not be covered, passing the full financial responsibility of contraceptive services to the customer. Employers who choose to exercise the accommodation process will pass responsibility of covering contraceptive services to the carrier or TPA, alleviating the financial responsibility from their employees and their dependents.
If you are a Cigna customer and have questions about Preventive Services covered under your plan, please check your plan coverage on myCigna.com or call the customer service number on the back of your ID card.
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