This week the Departments of Health and Human Services (HHS), Labor, and Treasury issued frequently asked questions (FAQs) to help insurance companies better understand the scope of coverage that is required (including contraceptive care) under the Affordable Care Act (ACA) and to help people better the ACA and benefit from it as intended.
This guidance follows recent Kaiser Family Foundation and research that reported variation in how the ACA contraceptive coverage provisions were being interpreted and implemented by health plans.
Some main points of interest:
- All non-grandfathered plans and insurers must cover, without cost sharing, at least one form of contraception within each of the 18 methods of contraception that the FDA has identified for women.
- If an item or service is not covered but is determined medically necessary by the woman’s attending provider, there must be an easily accessible process for the woman to get that item or service;
- If an insurer covers dependent children, recommended preventive services for women (such as preconception and prenatal care) must be covered for the dependent children as well (i.e., not just the parent(s) on the plan); and
Clarifies that insurance companies may still use reasonable medical management techniques within each of the methods of contraception (there are currently 18 identified by the FDA for women). For example, a plan can discourage the use of brand name over generic pharmacy items through cost sharing.