The U.S. Department of Health and Human Services (HHS) has issued guidelines to ensure that all women have access to preventive health services necessary for women's health and wellbeing. These new guidelines require health plans and health insurance issuers to cover the recommended women's preventive health services without charging a copayment, co-insurance, or deductible for in-network services. Non-grandfathered health plans and health insurance issuers will need to cover these services without member cost sharing, effective on plan years beginning on or after August 1, 2012.
Additionally, certain religious employers may be exempt from covering contraceptive services. In order to accommodate employers that are uncertain of whether the religious exemption applies to their organization, the federal government has instituted a temporary safe harbor period until the first plan year that begins on or after August 1, 2013. HHS clarified and reissued on August 15, 2012 the following criteria:
The organization is organized and operates as a non-profit-entity;
From February 10, 2012 onward, the group health plan established or maintained by the organization has consistently not provided all or the same subset of the contraceptive coverage otherwise required at any point, consistent with any applicable State law, because of the religious beliefs of the organization.
The group health plan established or maintained by the organization (or another entity on behalf of the plan, such as a health insurance issuer or third-party administrator) must provide notice to participants which states that some or all contraceptive coverage will not be provided under the plan for the first plan year beginning on or after August 1, 2012.
The organization self-certifies that it satisfies the aforementioned criteria and documents its self-certification in accordance with procedures prescribed in the guidance.
Please consult your legal counsel to determine your eligibility or the safe-harbor period.
The women's preventive health services recommended by the Department of Health and Human Services include the following types of preventive services:
Blue Cross Blue Shield of Massachusetts health plans currently provide in-network coverage, without copayment, co-insurance, or deductible, for most of these recommended women's preventive health services. Effective on renewals beginning on and after August 1, 2012, health plan changes will be made to include in-network coverage, without copayment, co-insurance, or deductible, for those recommended preventive health services not already covered (such as breastfeeding services and birth control prescription drugs and devices).
For more information and details about your health plan's preventive health benefits, refer to the evidence of coverage for your health plan. Coverage for all recommended preventive health services is subject to the health plan's provisions including network requirements.
For more information, please visit the U.S. Department of Health and Human Services.
This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.
Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.
For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.