The U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) have issued Frequently Asked Questions (FAQs) 54 concerning contraception requirements for group health insurance plans under the Affordable Care Act (ACA).
The ACA requires certain non-grandfathered group health plans and individual insurance to cover preventative services without cost sharing or at no cost to plan participants. Preventative services include care designed to identify or prevent illness, injury, or a medical condition rather than treat an existing illness, injury, or medical condition. Under the ACA, preventative services include women’s preventative health care and screenings, as the Health Resources and Services Administration (HRSA) recommends. HRSA guidelines require coverage of all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity, as prescribed by a healthcare provider.
FAQs 54 provides more specific details about the mandatory coverage of contraception under the ACA, including the following:
- Plans must cover items and services that are integral to the furnishing of a recommended service, including anesthesia for a tubal ligation procedure, or pregnancy tests needed before providing certain forms of contraception, such as an intrauterine device.
- Plans and issuers may use reasonable medical management techniques for contraceptive services or FDA-approved, cleared, or granted contraceptive products that are not included in a category described in the HRSA-Supported Guidelines.
- The HRSA-Supported Guidelines include “screening, education, counseling, and provision of contraceptives,” including instruction in fertility awareness-based methods, including lactation amenorrhea.
- Plans must cover emergency contraception, including over-the-counter products, when an attending medical provider prescribes the product.
- An HSA, health FSA or HRA can reimburse an individual for the cost (or portion of the cost) incurred for over-the-counter contraception, if not paid or reimbursed by another plan or coverage; and
- The ACA rules for preventive services preempt state law.
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