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Women’s Preventive Services Coverage and Non-Profit Religious Organizations

Because of the Affordable Care Act, most health plans cover recommended women’s preventive services, including contraception prescribed by a health care provider, without charging cost sharing, like a co-pay, co-insurance, or a deductible. The independent Institute of Medicine (IOM) provided recommendations to the Department of Health and Human Services (HHS) regarding which preventive services help keep women healthy and should be covered without cost sharing. The IOM recommended covering all FDA-approved contraception for women available with a prescription, without cost-sharing, because there are tremendous health benefits for women that come from using contraception. In fact, nearly 99 percent of women in the United States have relied on contraception at some point in their lives, but more than half, between the ages of 18 and 34, have struggled to afford it.

Today’s final rules provide women with coverage for recommended preventive care, including all FDA-approved contraceptive services prescribed by a health care provider, without cost-sharing, while ensuring that non-profit religious organizations that object to contraceptive coverage on religious grounds do not have to contract, arrange, pay, or refer for such coverage for their employees or students. The final rules released reflect public feedback on the Notice of Proposed Rulemaking issued in February 2013.

Exemption for Religious Employers

Group health plans of “religious employers” are exempted from having to provide contraceptive coverage. The final rules simplify the prior definition of a “religious employer” for purposes of the exemption.

Specifically, the final rules eliminate the requirements that a religious employer:

  1. have the inculcation of religious values as its purpose;
  2. primarily employ persons who share its religious tenets; and
  3. primarily serve persons who share its religious tenets.

The simplified definition of “religious employer” for purposes of the exemption is based solely on Section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code, which primarily concerns churches and other houses of worship.

This change is intended to clarify that a house of worship is not excluded from the exemption because it provides charitable social services to, or employs, persons of different religious faiths. It does not expand the universe of group health plans that qualify for the exemption beyond that which was originally intended.

Accommodations for Additional Non-Profit Religious Organizations

The final rules also provide accommodations for non-exempt, non-profit religious organizations that object to contraceptive coverage on religious grounds. An eligible organization is one that:

  1. on account of religious objections, opposes providing coverage for some or all of any contraceptive services otherwise required to be covered;
  2. is organized and operates as a nonprofit entity;
  3. holds itself out as a religious organization; and
  4. self-certifies that it meets these criteria in accordance with the provisions of the final regulations.

Under an accommodation, an eligible organization does not have to contract, arrange, pay or refer for contraceptive coverage. At the same time, separate payments for contraceptive services are available for women in the health plan of the organization, at no cost to the women or to the organization.

With respect to insured health plans, including student health plans, to be eligible for the accommodation, an eligible organization must provide a copy of its self-certification to its health insurance issuer. These plans must then provide separate payments for contraceptive services for the women in the health plan of the organization, at no cost to the women or to the organization. As explained in the final rules, issuers will find that providing such payments is cost-neutral.

With respect to self-insured health plans, to be eligible for the accommodation, an eligible organization must provide a copy of its self-certification to its third party administrator. The third party administrator must then provide or arrange separate payments for contraceptive services for the women in the health plan of the organization, at no cost to the women or to the organization. The costs of such payments can be offset by adjustments in Federally-facilitated Exchange user fees paid by a health insurance issuer with which the third party administration has an arrangement.

The final rules on women’s preventive services coverage are available here: http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf - Opens in a new window

For more information on women’s preventive services coverage visit: http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html - Opens in a new window

For required health plan coverage guidelines for women’s preventive services visit: http://www.hrsa.gov/womensguidelines - Opens in a new window

For technical guidance on the temporary enforcement safe harbor visit: http://cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/preventive-services-guidance-6-28-2013.pdf

For the self-certification form for eligible organizations visit: http://cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/index.html#Prevention