The DOL, IRS and the HHS issued an amendment to the Patient Protection and Affordable Care Act (PPACA) Preventive Care regulations allowing an exemption from certain guidelines for religious employers. In addition, HHS also approved of the preventive care services guidelines recommended by the Health Resources and Services Administration (the task force mandated to determine which preventive care services should be covered for women).

Under PPACA, nongrandfathered plans must provide coverage for certain listed preventive care services without imposing any cost-sharing requirement. The regulations provide a list of which preventive care services a non-grandfathered plan must cover (the list can also be found here.) In addition, the regulations note that plans must cover newly issued recommendations and guidelines for the first plan year beginning on or after the date that is one year after the date the recommendation or guideline was issued.  

The amendment to the regulations allows the Health Resources and Services Administration to exempt certain religious employers from the guidelines where contraceptive services are concerned. Under the amendment, a religious employer is one that "(1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization" that is a church, a church's integrated auxiliaries, conventions or associations of churches, or the exclusively religious activities of any religious order.  

The amendment was in response to the following recommended guidelines for women's preventive care services that HHS adopted:

  • well-woman visits (annual);
  • screening for gestational diabetes (pregnant women in their 24th and 28th weeks and first prenatal visit for high-risk women);
  • human papillomavirus (HPV) DNA testing for women age 30 years and older (no more frequently than every three years);
  • sexually transmitted infection counseling (annual);
  • human immunodeficiency virus (HIV) screening and counseling (annual);
  • FDA-approved contraception methods and contraceptive counseling (as prescribed);
  • breastfeeding support, supplies, and counseling (in conjunction with each birth); and
  • domestic violence screening and counseling (annual).

Nongrandfathered plans must cover these services without any cost sharing for the first plan year beginning on or after August 1, 2012. Grandfathered plans are not required to cover preventive care services without cost sharing until they lose their grandfathered status.