Effective August 1st health plans are required to provide preventive health services for women including contraception at no cost to the worker or patient. Since most plans operate on a calendar year basis the effective date for many people will be January 2013.
Here is what the final regulation says:
Section 2713 of the PHS Act, as added by the Affordable Care Act and incorporated into ERISA and the Code, requires that non-grandfathered group health plans and health insurance issuers offering group or individual health insurance coverage provide benefits for certain preventive health services without the imposition of cost sharing. These preventive health services include, with respect to women, preventive care and screening provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) that were issued on August 1, 2011 (HRSA Guidelines). 1 As relevant here, the HRSA Guidelines require coverage, without cost sharing, for ‘‘[a]ll Food and Drug Administration [(FDA)] approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,’’ as prescribed by a provider. Except as discussed below, [referring to religious employer delay] non-grandfathered group health plans and health insurance issuers are required to provide coverage consistent with the HRSA Guidelines, without cost sharing, in plan years (or, in the individual market, policy years) beginning on or after August 1, 2012. 2 These guidelines were based on recommendations of the independent Institute of Medicine, which undertook a review of the evidence on women’s preventive services.
All this with regard to contraceptives is based on the logic that holds if the employer is not paying for such services, female employees and spouses will become pregnant. Here is an excerpt from federal regulations:
In addition, there are significant cost savings to employers from the coverage of contraceptives. A 2000 study estimated that it would cost employers 15 to17 percent more not to provide contraceptive coverage in employee health plans than to provide such coverage, after accounting for both the direct medical costs of pregnancy and the indirect costs such as employee absence and reduced productivity.
Even if such logic were correct, where does it say the coverage must be free to the employee? One could argue that an employer could save money if all health care and prescriptions were free on the basis workers don’t take their prescriptions or visit the doctor because they don’t want to pay the coinsurance or small co-pay.
Oh well, the battle goes on. In Colorado an employer (non-religious) has won a stay from compliance based on its objection on religious grounds.
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