Insurers Must Cover Birth Control, Other Preventive Services

The US Department of Health and Human Services (HHS) has unveiled guidelines that require new 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 Affordable Care Act helps stop health problems before they start,” said HHS Secretary Kathleen Sebelius in a statement. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.”

A significant number of Americans don’t receive the preventive health care they need to maintain good health, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. In fact, HHS estimates that Americans use preventive services at about half the recommended rate, with cost being a top factor.

In 2010, HHS released new insurance market rules under the Affordable Care Act requiring all new private health plans to cover several evidence-based preventive services like mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance. The Affordable Care Act also made recommended preventive services free for individuals on Medicare.

The new guidelines take it a step further by ensuring that 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; and
• Domestic violence screening and counseling.

New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012. 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 administration also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services. This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.

Previously, preventive services for women had been recommended one-by-one or as part of guidelines targeted at men as well. As such, the HHS directed the Institute of Medicine (IOM) to conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep women healthy.

To access the IOM report—Clinical Preventive Services for Women: Closing the Gaps—click here.

For more information on the HHS guidelines, click here.