Ask the Experts about Health Care Reform

Medical still life with keyboard on wooden table

Welcome to SIA Group’s new blog series – Ask the Experts.  With ever-changing  laws and regulations it can be hard to stay up to date and remain compliant. It’s no surprise you have questions. The good news, we’ve got the answers.

Topic: Health Care Reform and Benefits

Question: Our company’s group medical plan covers in-network preventive care, including contraceptives, at 100%. Do the new federal rules about exemptions from mandated contraceptive coverage affect us?

Answer: Probably not. The federal agencies that write the Affordable Care Act (ACA) regulations recently issued new rules to allow more employers to exclude contraceptive coverage from their health plans. The exemptions are optional, however, so employers do not have to make any changes. For employers that object to including the coverage based on religious or moral convictions, the new rules expand the available exemptions.

The ACA generally requires non grandfathered health plans to cover specific preventive care services at 100%. The list of services includes prescribed contraceptives. (Over-the-counter items are not covered by health plans.) Religious employers, such as churches, have always been exempt from covering contraceptives. The ACA also provides an accommodation process for religiously-affiliated nonprofit employers, such as various hospitals and colleges, to carve out contraceptive coverage. Closely-held for-profit companies have also been able to use the accommodation based on their owners’ religious beliefs.

The new rules expand the current exemptions so that any employer, including nonprofit organizations and for-profit companies, may claim a religious objection to covering contraceptives. Further, any employer, other than a publicly-traded company, may claim a moral objection to providing the coverage.

To recap, the new rules do not require any employer to make changes but merely expand the available exemptions. State insurance laws may not offer the same broad scope of exemptions. Carriers that operate in the state can provide information about that state’s laws.