Earlier this week, the Department of Health and Human Services (HHS) issued detailed guidelines regarding women’s health care services that group health plans and health insurance policies must cover without cost-sharing pursuant to Section 2713 of the Patient Protection and Affordable Care Act, as amended (ACA). These guidelines amend and supplement the interim final rules relating to coverage of preventive services that were issued on July 19, 2010 (the Preventive Care Interim Final Rules). Proskauer’s Client Alert on the Preventive Care Interim Final Rules can be found here: [dated July 22, 2010].
The guidelines mandate that group health plans and health insurance policies cover the following women’s health care services without requiring a co-payment, co-insurance or deductible:
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The guidelines apply to the first plan year that begins on or after August 1, 2012, which means that for calendar year plans the guidelines will be effective beginning January 1, 2013. The release and effective date were specifically intended to ensure that plans covering college students, which commonly begin new policy years in August, are subject to the guidelines for the 2012-2013 plan year.
In connection with the release of the guidelines, the Department of Treasury, the Department of Labor and HHS jointly issued an additional amendment to the Preventive Care Interim Final Rules that allows HHS to establish an exemption from the requirement to provide contraception for religious employers. A definition of “religious employer” that is based on the existing definition used by most States that require coverage of contraceptives, but exempt religious employers from this requirement, is also included in the amendment.
The requirements to cover certain preventive care services, including these women’s health services, do not apply to grandfathered plans. Proskauer’s Client Alerts on the grandfather rules under ACA can be found here: [dated April 1, 2010; June 21, 2010; and November 16, 2010].