Health & Fitness
Health Reform The Debate on Coverage of Contraceptive Services
Employer groups should have the ability to choose their coverage as they see fit since the majority of the premium is paid for by the employer's money.
Under the Affordable Care Act, certain preventive services are required to be covered without cost-sharing. In August 2011, HHS released expanded guidelines for plans and insurers focusing on women’s health issues. For plan years beginning on or after August 1, 2012, non-grandfathered group health plans (fully insured and self-insured) and health insurance carriers offering group or individual health insurance coverage must cover, among other things, all FDA approved contraceptive methods for women at 100%. Although 28 states currently require insurance plans sold in the state to cover contraceptives to varying degrees, self-insured plans will be impacted by this new law since the state mandates generally do not apply to self-insured plans.
The 2011 regulations mentioned above allows churches, other houses of worship and similar organizations an exemption from covering contraception on the basis of their religious objections. In addition to this exemption, a final rule has been recently issued that applies to a larger set of religiously-affiliated organizations (such as faith-based hospitals and universities) and allows them a one-year grace period where they do not have to comply with this law. During this grace period, it is expected that the IRS, DOL and HHS will develop rules requiring that where religiously-affiliated organizations choose not to provide contraceptive coverage, it must be provided by the insurance company directly, free of charge, without involving the employer. We expect to get additional details on this, including how this will impact self-insured plans, during the transition year.
That being said, it's hard to understand how an insurance company would provide any kind of coverage without charging a direct premium. Even an indirect premium charge is still collecting a premium for a covered service. The debate going on today involves religious organizations who do not wish to pay for this coverage. In today's insurance market here in PA, contraceptives are usually included in group plans, and that includes devices in addition to drugs, sterilization and even abortion.
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Most employer groups do not even realize that the coverage is there. I did have a client once who insisted that it be removed from their coverage, and their insurer did remove it. However the premium increased by about 4% because of that. Point is, that the employer had the choice, made the choice and backed it up by paying increased premiums. Under the Affordable Care Act, no employer with group insurance could make a choice.
I'm not sure that's the right thing to do. I think the employer groups should have the ability to choose their coverage as they see fit since the majority of the premium is paid for by the employer's money. Since when is having a choice a bad thing? How do you feel about that?
