Implementing Health Reform: Clarifying Requirements For Coverage Of Contraceptives And Other Preventive Services

The Affordable Care Act requires nongrandfathered individual and group insurers and group health plans to cover certain preventive services without cost sharing. Specifically, it requires coverage of:

evidence-based items and services given an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) with respect to the individual involved;
immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control;
children’s preventive care and screenings as recommended by Health Resources and Services Administration (HRSA) guidelines;
Women’s preventive care and screenings as recommended by HRSA guidelines. The HRSA guidelines specifically require coverage of all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity, as prescribed by a health care provider.

If the relevant preventive services recommendation or guideline does not specify the frequency, method, treatment, or setting for a recommended preventive service, the ACA allows the insurer or health plan to use reasonable medical management techniques to limit coverage.
Reports Of Coverage Omissions
Despite these requirements, there have been reports recently of plans failing to cover recommended preventive services, and more specifically contraceptives. A report from the Kaiser Family Foundation of contraceptive coverage in five states found that many plans ...

Source: Health Affairs Blog - May 12, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptives Prevention Source Type: blogs