One highly lauded provision of the Affordable Care Act is the requirement that non-grandfathered health plans offer certain types of preventive health care services without cost-sharing in the first plan year beginning on or after August 1, 2012. The prohibition on cost-sharing includes a ban on charging participants any deductible, co-payment or similar cost-sharing amount. Co-payments may still be charged for office visits when the preventive care service is billed separately (or tracked as separate encounter data) or when the office visit does not primarily pertain to the preventive care service. Co-payments may also be charged for out-of-network care.
Federal health agencies issued guidelines identifying the preventive care services that must be covered under health care reform. When new services are added to those guidelines, a plan will have one year to cover the services at 100 percent.
Most recently, certain services applicable to women's health issues have been identified as "preventive" and required to be covered by group health plans. These women's health service requirements did not cause a stir when they were initially released in August 2011, but they have recently been the center of controversy.
The Department of Health and Human Services commissioned a study to review what preventive services are necessary for women's health and well-being. The commission recommended certain services be covered, including, among others, well-women visits, screening for gestational diabetes, HPV testing, and contraceptive methods and counseling.
Original guidance excepted group health plans sponsored by certain religious employers from the requirement to cover contraceptive services. A religious employer was defined as 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. The Obama administration caused an outrage when it recently announced that church-related employers, such as charities and hospitals, would not be considered a religious employer for purposes of the exemption. Backpedaling on this pronouncement, the Administration has now stated that if a woman's employer is a charity, hospital or other religious organization that has a religious objection to providing contraceptive services as part of its health plan, the insurance company, and not the employer itself, will be required to reach out to the employee and offer contraceptive care free of charge. Controversy remains over how self-funded plans will address the mandate.
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