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Protection of Conscience Project

Service, not Servitude
Legal Commentary

Women's Preventive Services

Required Health Plan Coverage Guidelines  [Full text]

U.S. Department of Health and Human Services


The Obama administration has decided that, as a matter of public policy, individual women should not have to pay for "FDA approved contraceptive services," which include surgical sterilization, contraceptives and embryocides.  The reasons offered for this policy are mainly economic and socio-political. 

Since sterilization and birth control have to be paid for by someone, the administration intends to force others to pay for them through insurance plans, even if they object to doing so for reasons of conscience or religion.

The preventive services regulation written by the U.S. Department of Health and

Contrary to an administration statement  on 10 February, 2012, the regulation has not been changed to accommodate objecting religious believers.  The wording and legal effect of the regulation remains exactly as it was when it was announced on 20 January, 2012.

 Human Services requires all health insurance plans to pay fully for every service described in Section 147.130 of the regulation.  Among these are all services for women that are identified in "binding comprehensive health plan coverage guidelines supported by the Health Resources and Services Administration."

These guidelines are reproduced below.  The combined effect of the statute, the regulation and the guideline is that eight types of service must be provided and paid for fully by insurance plans.  This will affect all employers who have 50 or more employees, since the law also requires them to offer such coverage by 2014, or face penalties.1

Within the context of freedom of conscience concerns, seven kinds of service are unremarkable.  However, the demand that employers must provide insurance coverage that fully pays for "contraceptive methods and counseling" is highly controversial for several reasons:

  • pregnancy is treated as a pathological condition like gestational diabetes, HPV infection and sexually transmitted diseases;
  • some religious denominations have moral objections to contraception, either absolutely or in certain cicumstances;
  • "contraceptive methods" as defined by the FDA are not limited to contraception, but include contraceptive sterilization, which may be considered gravely wrong by some religious denominations, either absolutely or in certain circumstances;
  • "contraceptive methods" as defined by the FDA  include methods that may not prevent conception, but may cause the death of a human embryo.  A number of religious denominations have strong moral objections to causing the death of an embryo, considering it the moral equivalent of abortion.


Health Resources and Services Administration Supported Women's Preventive Services: Required Health Plan Coverage Guidelines

Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.

Type of Service

HHS Guideline for Health Insurance Coverage


Well-woman visits.

Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.

Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman's health status, health needs, and other risk factors.* (see note)

Screening for gestational diabetes.

Screening for gestational diabetes.

In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.

Human papillomavirus testing.

High-risk human papillomavirus DNA testing in women with normal cytology results.

Screening should begin at 30 years of age and should occur no more frequently than every 3 years.

Counseling for sexually transmitted infections.

Counseling on sexually transmitted infections for all sexually active women.


Counseling and screening for human immune-deficiency virus.

Counseling and screening for human immune-deficiency virus infection for all sexually active women.


Contraceptive methods and counseling. ** (see note)

All Food and Drug Administration approved

As prescribed.

Breastfeeding support, supplies, and counseling.

Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.

In conjunction with each birth.

Screening and counseling for interpersonal and domestic violence.

Screening and counseling for interpersonal and domestic violence.


** Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services. A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii). 45 C.F.R. §147.130(a)(1)(iv)(B). See the Federal Register Notice: Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act

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.

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