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FAQs Issued for Contraceptive Coverage Mandate

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The Departments of Labor, Health and Human Services, and the Treasury (Departments) issued FAQs about the contraceptive coverage mandate under the Affordable Care Act (ACA). The FAQs clarify the mandate's scope, discuss noncompliance, and introduce a new optional approach for covering FDA-approved contraceptives.

Contraceptive Coverage Mandate

The ACA mandates that health plans and issuers cover preventive care services without cost sharing, including contraceptives outlined in Health Resources and Services Administration (HRSA) guidelines. Exemptions are available for religious and eligible employers with objections.


Noncompliance Reports

The Departments are aware of reports of widespread barriers to contraceptive coverage, including unreasonable medical management techniques. Examples include step-therapy protocols, age-related restrictions, burdensome administrative requirements, and cost sharing for integral services.


New Optional Approach

To address compliance problems, the FAQs describe a new optional approach called the therapeutic equivalence approach. This approach allows health plans and issuers to cover all FDA-approved contraceptive drugs and devices without cost sharing, except for those with therapeutic equivalents. It also provides an exceptions process for individuals to access medically necessary therapeutic equivalent products without cost sharing.

This new approach may apply to employers’ coverage of contraceptive drugs and drug-led devices. Employers should review their health plan’s contraceptive coverage for compliance with the ACA mandate. Download the bulletin for more details.

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National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.

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Erin Woulfe

Erin Woulfe

Erin Woulfe likes to write about things that matter. Keeping her finger on the pulse of what’s happening in the public sector world, she blogs about the latest legislative news and employee benefit trends that affect our school, city and county clients. She’s been with NIS since 2002. “I love connecting to our clients and providing them with the tools they need in order to administrate their plan,” says Erin. “Whether that be materials to educate their employees on certain benefits, how to effectively communicate change within an organization, or providing tips and how-to’s to help them make their job easier.”