As explained in a previous SGR Client Alert, under the Patient Protection and Affordable Care Act ("PPACA"), non-grandfathered group health plans and issuers are required to cover certain preventive care services without imposing any cost-sharing requirements (e.g., co-payments, coinsurance, or deductibles).  In July 2010, the Departments of Health and Human Services ("HHS"), Labor and the Treasury (the "Agencies") issued interim final regulations implementing the preventive service rules, which became effective for plan years beginning on or after September 23, 2010 - January 1, 2011 for calendar year plans.

New Guidelines for Women's Preventive Services

On August 1, 2011, HHS provided additional guidance on the preventive care requirements applicable to women participants in a group health plan based on a study by the Institute of Medicine.

These guidelines include:

  • Well-woman visits;
  • Gestational diabetes screenings;
  • HPV DNA testing;
  • Sexually transmitted infection and HIV screening and counseling;
  • Contraception and contraceptive counseling;
  • Breastfeeding support, supplies, and counseling; and
  • Domestic violence screenings.

Non-grandfathered group health plans and issuers are required to provide coverage without cost-sharing for the above-listed services effective for the first plan year that begins on or after August 1, 2012 - January 1, 2013 for calendar year plans.

Contraceptive Services Exemption for Religious Employers

The Agencies also amended the July 2010 preventive service regulations to exempt certain "religious employers" from the requirement to cover contraceptive services under the new guidelines.  For purposes of this exemption, a "religious employer" is an organization (1) that primarily employs and serves persons who share the religious beliefs of the organization, (2) with the primary purpose of teaching religious values, and (3) is a non-profit organization under the requirements of the Internal Revenue Code.