Federal agencies say major medical plans should include coverage for well-woman visits, contraception, screening for the viruses that cause AIDS and human papillomavirus, and breastfeeding support in the basic package of preventive health services benefits.
The U.S. Department of Health and Human Services (HHS) announced the women’s preventive services package today and based the required services on recommendations from the Institute of Medicine (IOM), Washington.
In addition to services such as well-woman visits and contraception, group plans and individual policies must cover screening for gestational diabetes, sexually transmitted infection counseling, breastfeeding supplies and counseling, and domestic violence screening and counseling, HHS officials say.
The Health Resources and Services Administration (HRSA), an arm of HHS, developed the women’s services package to implement the preventive health services provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
PPACA requires affected group health plans and individual health insurance policies to provide basic preventive health services without applying cost-sharing provisions, such as deductible or co-payment requirements, for those services.
New health plans must require the basic women’s basic preventive health services package without cost-sharing for plan or policy years beginning on or after Aug. 1, 2012, officials say.
The contraception coverage requirement applies to drugs and devices approved by the federal Food and Drug Administration.
HHS and two other agencies, the Internal Revenue Service and the Employee Benefits Security Administration, also have released an amendment to the federal PPACA preventive health services package regulations.
The amendment, implemented in the form of a final rule with a request for comments, will give religious institutions that offer health coverage to their employees the choice of whether or not to cover contraception services.
The exemption is not available for individual health insurance policies, officials say.
When HRSA first proposed the women’s preventive health services coverage requirements, “most commenters, including some religious organizations, recommended that HRSA guidelines include contraceptive services for all women and that this requirement be binding on all group health plans and health insurance issuers with no religious exemption,” federal officials say in the preamble to the religious exemption regulations. “However, several commenters asserted that requiring group health plans sponsored by religious employers to cover contraceptive services that their faith deems contrary to its religious tenets would impinge upon their religious freedom. One commenter noted that some religious employers do not currently cover such benefits under their group health plan due to their religious beliefs.”
Federal agencies want to provide for “a religious accommodation that respects the unique relationship
between a house of worship and its employees in ministerial positions,” officials say. “Such an accommodation would be consistent with the policies of states that require contraceptive services coverage, the majority of which simultaneously provide for a religious accommodation.”
The exemption would apply to churches, integrated auxiliaries, and conventions or associations of churches, and to “the exclusively religious activities of any religious order,” officials say.
The exemption applies only to group health plans because HRSA has no discretion to establish an exemption for the individual health insurance market, officials say.
America’s Health Insurance Plans (AHIP), Washington, has put out a statement contending that the proposed women’s health services packages would increase costs without necessarily lowering overall health care costs or improving the quality of care.
“Health plans have long provided coverage for evidence-based preventive services, including the vast majority of services recommended by the Institute of Medicine,” AHIP President Karen Ignagni says in the statement. “We appreciate that the administration’s guidance recognizes the value of health plans’ programs designed to ensure patients are receiving the safest, highest-quality care. “Unfortunately, the preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage.”
In some cases, the recommendations would encourage consumers to get prescriptions for supplies now purchased over-the-counter, Ignagni says.
“Exceeding current evidence-based guidelines sets a troubling precedent for the IOM’s future coverage recommendations, including essential health benefits that will significantly impact the affordability of coverage and the cost to taxpayers,” Ignagni says.