The Obama administration issued proposed rules for public comment regarding contraceptive coverage with no cost sharing under the Affordable Care Act (ACA). The proposed rules provide women with coverage for preventive care that includes contraceptive services with no co-pays. Importantly, the rule accounts for concerns of some religious organizations by extending accommodations that provide enrollees separate contraceptive coverage with no co-pays, but at no cost to the religious organization. Insured plans: For insured plans, including student health plans, the religious organizations would be required to provide notice to their insurer. The insurer would then be responsible for notifying enrollees that it is providing them with no-cost contraceptive coverage through separate individual health insurance policies. Self-insured plans: For self-insured plans, as well as student health plans, religions organizations would be required to notify third party administrators. The third party administrator would then work with an insurer to arrange no-cost contraceptive coverage through separate policies. Additionally, the proposed rules provide a detailed definition of "religious employer” for the purposes of the exemption. Click here for a fact sheet.

The Center for Consumer Information and Insurance Oversight (CCIIO) of the U.S. Department of Health and Human Services (HHS) has issued a bulletin providing further guidance on the coverage of contraceptive services without cost sharing. In an August 2011 interim final rule (IFR), HHS required non-grandfathered health plans to provide such coverage beginning August 1, 2012, but also included a temporary safe harbor from enforcement in the rule for employers objecting based on religious reasons. In this latest guidance, CCIIO clarifies what types of employers are eligible for the safe harbor and when specifically it can be invoked. To qualify for the temporary enforcement safe harbor and thus be excluded from the contraceptive coverage mandate, organizations must be nonprofits, from February 10, 2012 onward, they must not have provided contraceptive coverage due to religious beliefs; they are mandated to disclose to participants that contraceptives are not covered; and they must self-certify that they satisfy the three aforementioned criteria. The Obama administration noted that the ACA provision would provide women with access to preventive services, including contraceptives, without cost sharing, while ensuring nonprofit religious organizations are not forced to cover any contraceptive service to which they object.

Today, 47 million women receive access to eight new preventive health care services without copay. The Affordable Care Act (ACA) provision requires plans to cover the following services: * Well-woman visits. * Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases. * Domestic and interpersonal violence screening and counseling. * FDA-approved contraceptive methods, and contraceptive education and counseling. * Breastfeeding support, supplies, and counseling. * HPV DNA testing, for women 30 or older. * Sexually transmitted infections counseling for sexually-active women. * HIV screening and counseling for sexually-active women. The aforementioned covered services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. Group health plans and plans that have maintained grandfathered status are not required to cover the new services. Additionally, certain religious institutions are also exempt.