In a set of Frequently Asked Questions (FAQs) issued on May 11, the federal agencies regulating the implementation of the Affordable Care Act (ACA) sought to close some loopholes that health insurers thought they had detected regarding preventive and contraceptive services.
Regarding contraceptive services, the FAQs by the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury (DOT) wrote:
Plans and issuers must cover without cost sharing at least one form of contraception in each of the methods (currently 18) that the FDA [Food and Drug Administration] has identified for women in its current Birth Control Guide. This coverage must also include the clinical services, including patient education and counseling, needed for provision of the contraceptive method.
However, cost sharing can be used to discourage participants from choosing higher-priced options, while at last one form in each category remains cost-free. (If a woman’s doctor deems one of the higher-priced alternatives as “medically necessary,” then the insurer must cover it cost-free.)
In other FAQs, the departments noted other services that must be covered without copays or cost sharing:
- Anesthesia involved with colonoscopies
- Certain preventive services for transgender persons
- Prenatal care and other services to promote health pregnancies
- Preventive screening, genetic counseling and BRCA genetic testing for women at risk
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