The Department of Health and Human Services, commonly called HHS, recently added an update to the Interim Final Regulations for Women’s Preventative Care on August 1, 2011. This preventative program is regulated under the Patient Protection and Affordable Care Act, which is commonly called PPACA. Recent changes were developed by the Institute of Medicine to make the plan more beneficial. The institute’s orders to review which services are necessary for women’s health came from HHS. This new amendment outlines additional guidelines for Preventative Services and the needed alterations of policy provisions in health plans in the near future. The change applies to all plans that are classified as Non-Grandfathered. This includes health policies, insured plans and self-insured group health policies. With this change, health plans must cover Preventative Services. The outline includes a provision for birth control without deductibles or copay amounts.
This change applies to Non-Grandfathered plan year starting on or following August 1, 2012. After this time, they will be required to provide coverage without cost sharing for the following women’s Preventative Services:
- Annual well-woman visits to a healthcare provider
- Breastfeeding support, supplies, and counseling
- Gestational diabetes screenings
- Counseling for STIs
- HPV DNA testing for women over 30 years of age
- FDA-approved contraception methods and counseling for contraceptive users
- HIV screenings and counseling
- Domestic violence counseling and risk screening
There are some exemptions to these plans. Group health plans that are sponsored by some religious employers are exempt from the contraceptive coverage requirement. In addition to this, group health insurance coverage that has connections to such plans is also exempt from covering birth control for women. In definition, a religious employer is one that has the inculcation of religious values and its purpose, primarily serves people sharing religious tenets, is a non-profit organization under the IRC and is one who has a majority of employees sharing religious tenets.
Although these changes are nearly a year into the future, it is important to analyze the additional services’ impact on pricing. While these changes will benefit thousands of women across the country, the changes will certainly come with a price. Benefits Account Managers should keep abreast of of any additional changes and amendments affecting the Patient Protection and Affordable Care Act.
