Coverage of Certain Preventive Services
Under the Affordable Care Act
Federal Register, 6 February, 2013, p. 8456-8476
Amendments to rules regarding coverage for certain preventive services
under section 2713 of the Public Health Service Act.
text: 78 FR 8456]
The Obama administration has decided that, as a matter of public
policy, individual women should not have to pay for
contraceptive services," which include surgical sterilization,
contraceptives, and embryocides.
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.
A regulation was written by the U.S. Department of Health and
Human Services for this purpose. It was authorized by
the United States Code made by Section 1001 of the
Protection and Affordable Care Act, the American health care
reform law passed in 2010.
requires all group health care plans (the kind of plan usually
offered by businesses or oganizations) to offer coverage and
fully pay for "preventive services" identified in Section
147.130 (reproduced below, in part). Businesses with 50 or
more employees must offer such coverage by 2014, or face penalties.1
Health insurance issuers (like insurance companies) must also make
available group and individual plans that fully pay for "preventive
Most of the services are not
identified in the regulation. They are itemized in separate
recommendations and guidelines.
The regulation sparked widespread protests and opposition from
religious groups and, as of February, 2013, had generated
lawsuits launched by over 130 plaintiffs. 11 of 14 federal
courts hearing the suits issued temporary injunctions to protect
plaintiffs against the regulation.
In response, the Obama administration has issued proposed amendments
to the regulation, which are set out
- Mouse-over red text to see Project comments.
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:
Beginning at the time described in paragraph (b) of this
section and subject to Â§147.131, 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 requirement (such as a
copayment, coinsurance, or a deductible) with respect to those
items and services:
Â§ 147.131 Exemption and accommodations in connection with coverage of
preventive health services.
(a) Religious employers.
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) For purposes of this subsection, a "religious employer" is an
organization that meets all of the following criteria:
(1) The inculcation of religious values is
the purpose of the
(2) The organization primarily employs persons who share the
religious tenets of the organization.
(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.
In issuing guidelines under Â§147.130(a)(1)(iv), the Health
Resources and Services Administration establish an exemption from such guidelines with
respect to a group health plan established or maintained by a
religious employer (and health insurance coverage provided in
connection with a group health plan established or maintained by
a religious employer) with respect to any requirement to cover
such guidelines. For purposes of this paragraph (a), a
Proposed Amendment (new sections added)
(b) Eligible organizations.
An eligible is an organization that satisfies
all of the
(1) The organization opposes providing coverage for some or all of any
services required to be covered under Â§147.130(a)(1)(iv) on account of
(2) The organization is organized and operates as a .
(3) The organization holds itself out as a organization.
(4) The organization , made
in the manner and
form specified by the Secretary of Health and Human Services, for each plan
year to which the
accommodation is to apply, executed by a person authorized to make the
certification on behalf of the organization, indicating that the
organization satisfies the criteria in paragraphs (b)(1) through (3) of this
section, and, specifying those contraceptive services for which the
organization will not establish, maintain, administer, or fund coverage, and
certification available for examination upon request.
(c) Contraceptive coverage - insured group health plan coverage.
(1) A group health plan established or maintained by an eligible
organization and that provides benefits through one or more issuers
complies with any requirement under Â§ 147.130(a)(1)(iv) to provide contraceptive
coverage if the eligible organization or plan administrator each
issuer that would otherwise provide coverage for any contraceptive services
required to be covered under Â§ 147.130(a)(1)(iv) with a copy of the
self-certification described in paragraph (b)(4) of this section.
(2) A group health insurance issuer that receives a copy of the
in paragraph (b)(4) of this section with respect to a plan for which the
issuer would otherwise
provide coverage for any contraceptive services required to be covered under
Â§ 147.130(a)(1)(iv) must automatically provide health insurance coverage for
any contraceptive services required to be covered by Â§ 147.130(a)(1)(iv) and
identified in the self-certification,
through a separate health insurance
policy that is excepted under Â§ 148.220(b)(7) of this subtitle, for each
plan participant and beneficiary. The issuer providing the individual market
excepted benefits policy (such
as a copayment, coinsurance, or a deductible) with respect to coverage of
those services, or impose any premium, fee, or other charge, or portion
thereof, directly or indirectly, on the eligible organization, its group
health plan, or plan participants or beneficiaries with respect to coverage
of those services.
(d) Notice of availability of contraceptive coverage.
An providing contraceptive coverage arranged pursuant to paragraph
(c) of this section must provide to plan participants and beneficiaries
written notice of the availability of the contraceptive coverage, separate
from but contemporaneous with (to the extent possible) application materials
distributed in connection with enrollment (or re-enrollment) in group
coverage of the eligible organization for any plan year to which this
paragraph applies. The following model language, or substantially similar
language, may be used to satisfy the notice requirement of this paragraph:
"The organization that establishes and maintains, or
arranges, your health coverage has certified that your [group health
plan/student health insurance coverage] qualifies for an accommodation with
respect to the federal requirement to cover all Food and Drug
Administration-approved contraceptive services for women, as prescribed by a
health care provider, without cost sharing. This means that your health
coverage will not cover the following contraceptive services: [contraceptive
services specified in self-certification]. Instead, these contraceptive
services will be covered through a separate individual health insurance
policy, which is not administered or funded by, or connected in any way to,
your health coverage. You and any covered dependents will be enrolled in
this separate individual health insurance policy at no additional cost to
you. If you have any questions about this notice, contact [contact
information for health insurance issuer]."
(e) Application to student health insurance coverage.
The provisions of this section apply to student health insurance coverage
arranged by an eligible organization that is an in a manner comparable to that in which they apply to group health
insurance coverage provided in connection with a group health plan
established or maintained by an eligible organization that is an employer.
In applying this section in the case of student health insurance coverage, a
reference to "plan participants and beneficiaries" is a reference to student
enrollees and their covered dependents.
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.