Preventive services must be covered up front with no cost-sharing and no annual limits.
Overview
Section 2713 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act, requires coverage without cost sharing of certain preventive health services, including certain contraceptive services, in non-exempt, nongrandfathered group health plans and health insurance coverage.
This requirement was effective for non-grandfathered plans with the first renewal on or after September 23, 2010. In total, there are 15 covered preventive services for adults, 22 covered preventive services for women, including pregnant women, and 26 covered preventive services for children. More info here.
One of the more controversial requirements is that plans in the Health Insurance Marketplace cover contraceptive methods and counseling for all women, as prescribed by a health care provider. These plans must cover the services without charging a copayment, coinsurance, or deductible when they are provided by an in-network provider. There is no requirement to cover rugs to induce abortions or to cover services related to a man’s reproductive capacity, like vasectomies. More info here.
Additionally, the Affordable Care Act adds a number of new preventive and screening services to the Medicare program. More info here.
Regulations and Guidance
| Final Rules regarding Coverage of Women’s Preventive Services This document contains final regulations regarding coverage of women’s preventive services under section 2713 of the Public Health Service Act (07/02/2013) |
| HHS News Release “Administration issues final rules on contraception coverage and religious organizations” (06/28/2013) |
| HHS Fact Sheet: Affordable Care Act Rules on Expanding Access to Preventive Services for Women This HHS Fact Sheet provides information on the expanded preventive services for women under the Affordable Care Act. |
| HHS Fact Sheet: Women’s Preventive Services Coverage and Non-Profit Religious Organizations CMS fact sheet about the final rules on providing women with coverage for recommended preventive care, including all FDA-approved contraceptive services prescribed by a health care provider, without cost-sharing, while ensuring that non-profit religious organizations that object to contraceptive coverage on religious grounds do not have to contract, arrange, pay, or refer for such coverage for their employees or students. (07/02/2013) |
| Certification Form for Eligible Organizations | MS Word Format This form is to be used to certify that the health coverage established or maintained or arranged by the organization listed below qualifies for an accommodation with respect to the federal requirement to cover certain contraceptive services without cost sharing. |
| Updated Guidance on the Temporary Enforcement Safe Harbor Guidance on the temporary enforcement safe harbor for certain employers, group health plans and group health insurance issuers with respect to the requirement to cover contraceptive services without cost sharing. (06/28/2013) |
| Proposed Rules regarding Coverage of Certain Preventive Services This document proposes amendments to rules regarding coverage for contraceptive services under section 2713 of the Public Health Service Act. (02/06/2013) |
| HHS News Release “Administration issues Notice of Proposed Rulemaking on recommended preventive services policy” – press release about proposed rules for public comment regarding contraceptive coverage with no cost sharing under the health care law (02/01/2013) |
| Advance Notice of Proposed Rulemaking This advance notice of proposed rulemaking announces the intention of the Departments of Health and Human Services, Labor, and the Treasury to propose amendments to regulations regarding certain preventive health services under provisions of the Patient Protection and Affordable Care Act. (03/21/2012) |
| News Release “Administration releases Advance Notice of Proposed Rulemaking on preventive services policy” (03/16/2012) |
| Final Regulations Regarding Exemption These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act. (02/15/2012) |
| Amendment to Interim Final Rules | Public Comments This document contains amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services. (08/03/2011) |
| Interim Final Regulations | Public Comments Description This document contains interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services. (07/19/2010) |
| Preventive Services Covered Under the Affordable Care Act This web page provides detailed information about the preventive services covered under the Affordable Care Act. |
Videos
HHS Video: Preventive Services for Women and Families
Posted July 22, 2010. Secretary Sebelius discusses the Affordable Care Act and how it provides more access to treatment and preventive services for all Americans, especially women and families, with National Campaign Director at MomsRising Donna Norton, and actress and women’s health advocate Fran Drescher. Conducted in a Q&A format.
