Contraceptive Coverage Requirements Clarified

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After recent reports showed that health insurance issuers were excluding coverage of particular types of birth control or requiring copayments, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (collectively, the Departments) issued guidance clarifying the scope of coverage required under the Affordable Care Act.  In particular, the guidance provides that plans and issuers:

  1. Must cover at least one form of contraception in each of the 18 methods identified by the Food and Drug Administration (FDA) in its current Birth Control Guide.  The coverage must include any clinical services, including patient education and counseling, needed to provide the contraceptive method.
  2. May utilize reasonable medical management techniques within each method, including imposing cost-sharing on some items and services to encourage the use of specific items and services within a particular contraceptive method (e.g., a plan may use cost-sharing to encourage use of one of several FDA-approved intrauterine devices).
  3. Must have an easily accessible, transparent and sufficiently expedient exceptions process that is not unduly burdensome if using reasonable medical management techniques within a specified method of contraception.  If a provider recommends a particular FDA-approved service or item based on medical necessity, the plan or issuer must cover the item or service without cost-sharing.

The Kaiser Family Foundation created a chart summarizing the minimum contraceptive coverage requirements that is available here.

In addition to contraceptive coverage, FAQ (Part XXVI) also provides guidance on the coverage of BRCA testing and other preventive services, including well-woman care for dependents and colonoscopies.