By Danielle Capilla
Chief Com­pli­ance Offi­cer at Unit­ed Ben­e­fit Advisors

preventiveFed­er­al agen­cies released final reg­u­la­tions on the pre­ven­tive ser­vices man­date of the Patient Pro­tec­tion and Afford­able Care Act (ACA) that requires non-grand­fa­thered group health plans to pro­vide cov­er­age with­out cost-shar­ing for spe­cif­ic pre­ven­tive ser­vices, which for women include con­tra­cep­tive services.

After push­back from reli­gious employ­ers, inter­im final reg­u­la­tions, objec­tions from cer­tain employ­ers with reli­gious objec­tions and the sub­se­quent Supreme Court deci­sion in Bur­well v. Hob­by Lob­by, pro­posed reg­u­la­tions, fur­ther final reg­u­la­tions, addi­tion­al inter­im final reg­u­la­tions, and anoth­er set of pro­posed reg­u­la­tions, the 2015 Final Rules (applic­a­ble for plan years begin­ning on or after Sep­tem­ber 14, 2015) pro­vide the following:

  • For­mal­izes pri­or guid­ance requir­ing a plan to cov­er out-of-net­work ser­vices with­out cost shar­ing if the plan does not have an in-net­work provider who can pro­vide a required pre­ven­tive service.
  • Pro­vides for midyear plan changes if a rec­om­mend­ed pre­ven­tive ser­vice is down­grad­ed (by task force or advi­so­ry body) to a “D” rat­ing or is sub­ject to a safe­ty recall or oth­er sig­nif­i­cant safe­ty concern.
  • Pro­vides con­tra­cep­tive cov­er­age accom­mo­da­tions for eli­gi­ble organizations.

For all the details relat­ed to out of net­work cov­er­age, addi­tion­al pre­ven­tive ser­vice cov­er­age, tim­ing require­ments, con­tra­cep­tion, accom­mo­da­tions and impor­tant healthcare.gov links, down­load UBA’s free PPACA Advi­sor: “Pre­ven­tive Ser­vices Final Rules”.

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