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Title 45: Public Welfare [Full text]

Introduction:

This regulation was amended in June, 2013.  See  HHS Regulation (2013).

PART 147-HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS

§ 147.130 Coverage of preventive health services.
(a) Services -(1) In general.

Beginning at the time described in paragraph (b) of this section, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide coverage for all of the following items and services, and may not impose any cost-sharing requirements (such as a copayment, coinsurance, or deductible) with respect to those items or services:

(i) essentially repeats  §300gg-13(a)(1) in the statute.

(i) Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force with respect to the individual involved (except as otherwise provided in paragraph (c) of this section);

(ii) is drawn from §300gg-13(a)(2) in the statute, and explains how recommendations will be identified.

(ii) Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved (for this purpose, a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention, and a recommendation is considered to be for routine use if it is listed on the Immunization Schedules of the Centers for Disease Control and Prevention);

(iii) With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and

Subsection (iv) refers to legal guidelines that set out required "preventive care and screenings".  The meaning and effect of the regulation depends upon those guidelines.

(iv) With respect to women, to the extent not described in paragraph (a)(1)(i) of this section, preventive care and screenings provided for in binding comprehensive health plan coverage guidelines supported by the Health Resources and Services Administration.

(A) Note the word "may."  There is no requirement to provide an exemption, and any exemption provided can be revised or revoked by the Department.  "Contraceptive services" are defined in legal guidelines, not in this regulation. 

(A) In developing the binding health plan coverage guidelines specified in this paragraph (a)(1)(iv), the Health Resources and Services Administration shall be informed by evidence and may establish exemptions from such guidelines with respect to group health plans established or maintained by religious employers and health insurance coverage provided in connection with group health plans established or maintained by religious employers with respect to any requirement to cover contraceptive services under such guidelines.

(B) The definition of "religious employer" excludes individual religious believers [See B(4)].

(B) For purposes of this subsection, a "religious employer" is an organization that meets all of the following criteria:

(1) "The purpose" seems to imply "sole purpose."  Many organizations have more than one purpose, or have been established to act upon rather than inculcate religious values. Under the regulation, it would seem they are not "religious employers."

( 1 ) The inculcation of religious values is the purpose of the organization.

( 2 ) The organization primarily employs persons who share the religious tenets of the organization.


B(1), B(2) and B(3) effectively deny a religious exemption to most of the social, educational and charitable organizations operated by religious believers.

( 3 ) The organization serves primarily persons who share the religious tenets of the organization.

( 4 ) The organization is a nonprofit organization as described in section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended.

[75 FR 41759, July 19, 2010; 76 FR 46626, Aug. 3, 2011]

See the full text of the regulation.


Notes
Provided by the Protection of Conscience Project

1.  "The New Health Care Reform Law:  How Will it Affect Non-Profit Employers?"  The Arc, National Policy Matters, Issue #9, July 15, 2012.

2.  The term "contraceptives," as it is used in the guidelines (and, thus, the regulation) includes sterilization and drugs and devices that may cause the death of a human embryo before implantation ("embryocide").  For an explanation of this terminology, see Clearing Rhetorical Minefields.

3.  "These regulations finalize, without change, interim final regulations. . . .the amendment to the interim final rule with comment period amending 45
CFR 147.130(a)(1)(iv) which was published in the Federal Register at 76 FR 46621-46626 on August 3, 2011, is adopted as a final rule without change." "Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under Patient Protection and Affordable Care Act," p. 1, 20.  Scheduled for publication in the Federal Register on 15 February, 2012. (Emphasis added)

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