Secretaries Becerra, Walsh and Yellen Underscore Contraceptive Coverage Requirements for Private Insurance
Today, Secretaries Xavier Becerra, Marty Walsh, and Janet L. Yellen of the U.S. Departments of Health & Human Services, Labor and Treasury (Departments), respectively, issued a letter to group health plans and health insurance issuers reminding them of their obligations under the Affordable Care Act (ACA) to provide coverage for contraceptive services at no cost.
In all fifty states, the ACA guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling, for individuals and covered dependents. Recent reports have shown that some issuers and plans may not be appropriately providing this coverage. The letter is another step for the Departments to put the industry on notice for the required coverage and demand prompt action to ensure that people can rightfully access the birth control they need.
“The Biden-Harris Administration is committed to strengthening access to care and coverage. We are calling on the industry to remove impermissible barriers and ensure individuals have access to the contraceptive coverage they need, as required under the law,” wrote the Secretaries in the letter. “It is more important than ever to ensure access to contraceptive coverage with no out-of-pocket costs under the Affordable Care Act.”
“Reproductive health care is critical health care. The contraceptive coverage requirements under the Affordable Care Act have been in place for over a decade, and we expect plans and issuers to meet these obligations,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration is committed to ensuring access to health care for all, including access to contraceptive coverage at no cost to the individual.”
Plans and issuers are required to cover, at no cost, at least one form of contraception within each of the contraceptive categories identified by the U.S. Food and Drug Administration (FDA). This includes instances when an FDA-approved, -cleared, or -granted contraceptive product that is recommended by the individual’s medical provider does not fall within one of the identified categories. Specifically, plans and issuers are required to have an easily accessible, transparent, and sufficiently expedient exceptions process in place that ensures individuals can receive coverage without cost sharing for the FDA-approved, -cleared, or -granted contraceptive product that is medically appropriate for them. This coverage must also include the clinical services, including patient education and counseling, needed for provision of the selected contraception.
The Departments are concerned about complaints received regarding the industry’s failure to provide coverage of contraceptive services, without cost sharing, in a manner consistent with the standards set forth by the Departments. The Departments expect plans and issuers to immediately take steps to ensure that they are complying, and they may take enforcement or other corrective actions as appropriate.
Today, the Departments also convened a meeting with national leaders where the health insurance industry are expected to commit to promptly correcting all areas of potential non-compliance and to take specific actions to ensure that their members have access to contraceptive services at no cost.