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Text of ACA FAQs Part 54: Preventive Services Requirements for Contraceptive Coverage (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department Link to more items from this source
[Official Guidance]
July 28, 2022

13 pages. 14 Q&As. "Public Health Service (PHS) Act section 2713 and its implementing regulations ... require non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover, without the imposition of any cost-sharing requirements, [specified] items or services ... [P]lans and issuers must currently provide coverage consistent with the 2019 HRSA-Supported Guidelines, and must provide coverage consistent with the 2021 HRSA- Supported Guidelines beginning with plan years (in the individual market, policy years) starting on and after December 30, 2022. The guidance provided in these FAQs regarding the contraceptive coverage requirement under PHS Act 2713 is equally applicable to both the 2019 HRSA-Supported Guidelines and the 2021 HRSA-Supported Guidelines, unless otherwise specified....

  • "Are plans and issuers required to cover items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure? ...
  • "Are plans and issuers required to cover, without the imposition of any cost sharing, contraceptive products and services that are not included in a category of contraception described in the HRSA-Supported Guidelines? ...
  • "Are plans and issuers required to cover FDA-approved emergency contraception, including emergency contraception that is available over-the-counter (OTC)? ...
  • "Can a health savings account (HSA), health flexible spending arrangement (health FSA) or health reimbursement arrangement (HRA) reimburse expenses incurred for OTC contraception obtained without a prescription? ...
  • "How can a plan or issuer determine whether a medical management technique is reasonable for purposes of the requirements under PHS Act section 2713? ...
  • "If a plan or issuer utilizes medical management techniques within a category of contraceptives, what constitutes an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or their provider (or other individual acting as a patient's authorized representative)? ...
  • "May a plan or issuer require a participant, beneficiary, or enrollee to appeal an adverse benefit determination using the plan or issuer's internal claims and appeals process30 as the means for an individual to obtain an exception? ...
  • "Does federal law preempt a state law that prevents the application of PHS Act section 2713? ...
  • "What should an individual do if the individual has difficulty accessing contraceptive coverage under their group health plan or group or individual health insurance coverage?"

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