Title 45: Public Welfare [Full
PART 147-HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL
HEALTH INSURANCE MARKETS
Â§ 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
not impose any cost-sharing requirements (such as a copayment, coinsurance,
or deductible) with respect to those items or services:
(i) essentially repeats
Â§300gg-13(a)(1) in the statute.
(ii) is drawn from
Â§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
(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
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.
(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
in this paragraph (a)(1)(iv), the Health Resources and Services
Administration shall be informed by evidence and may
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
) The inculcation of religious values is
purpose of the
( 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.
) 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]
of the regulation.
Provided by the Protection of Conscience Project
"The New Health
Care Reform Law: How Will it Affect Non-Profit Employers?" The
Arc, National Policy Matters, Issue #9, July 15, 2012.
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
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)