The federal Treasury, DOL, and HHS (collectively, the “Agencies”) jointly issued a new set of FAQs to address various issues regarding the requirement for most employer-provided and other applicable group health plans to cover contraceptives without cost-sharing under the preventive care mandate of the Affordable Care Act (the “Contraceptive Coverage Mandate”). In particular, the FAQs are intended to (i) respond to reports that individuals continue to experience difficulty accessing contraceptive coverage without cost sharing; (ii) clarify application of the Contraceptive Coverage Mandate to fertility awareness-based methods and emergency contraceptives; and (iii) address the preemption of state law by the Contraceptive Coverage Mandate.
Specific issues addressed in the FAQs include the following:
- The requirement for plans to cover items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure;
- The requirement for a plan to cover, without cost-sharing, FDA-approved emergency contraception (levonorgestrel or ulipristal acetate), including products sold over-the-counter, when prescribed by a provider;
- Circumstances under which plans may use reasonable medical management techniques for the determination and application of coverage for contraceptive products or services; and
- The preemption of state laws that prevent the application of the Contraceptive Coverage Mandate.