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New HHS rules ban co-pays, deductibles for women’s health services

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in Compensation and Benefits,Human Resources

The U.S. Department of Health and Human Services (HHS) has issued new guidelines requiring health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or a deductible.

The requirements, announced Aug. 1, apply to insurance policies with plan years beginning on or after Aug. 1, 2012. For most employer-provided health plans, that means the effective date will be Jan. 1, 2013.

HHS issued the new guidelines under authority of the Affordable Care Act health reform law that took effect last year.

Last summer, HHS released similar insurance market rules requiring all new private health plans to cover preventive services such as mammograms, colonoscopies, blood pressure checks and childhood immunizations without charging a copayment, deductible or co-insurance.

According to an HHS statement, the new guidelines are designed to ensure women have access to a full range of recommended preventive services without cost sharing, including:

  • Well-woman visits
  • Screening for gestational diabetes
  • Human papillomavirus (HPV) DNA testing for women 30 years and older
  • Sexually-transmitted infection counseling
  • Human immunodeficiency virus (HIV) screening and counseling
  • FDA-approved contraception methods and contraceptive counseling
  • Breastfeeding support, supplies and counseling
  • Domestic violence screening and counseling.

The rules governing coverage of preventive services—which allow plans to use reasonable medical management to help define the nature of the covered service—apply to women’s preventive services.  Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.

The guidelines allow religious institutions that offer insurance to their employees to choose whether or not to cover contraception services.

Note: Your insurance company should be on top of this issue as your effective date approaches. Meanwhile, it’s likely that employees will have questions about the new coverage requirements. Touch base with your carrier or broker to find out where to send them for answers.

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