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[Official Guidance]
Text of DOL FAQs on ACA Implementation (Part XXVI): Coverage of Various Preventive Services (PDF)
7 Q&As; 7 pages. "If a recommendation or guideline does not specify the frequency, method, treatment, or setting for the provision of a recommended preventive service, the plan or issuer may use reasonable medical management techniques to determine any such coverage limitations.... Q1: Must a plan or issuer cover without cost sharing recommended genetic counseling and BRCA genetic testing for a woman who has not been diagnosed with BRCA-related cancer but who previously had breast cancer, ovarian cancer, or other cancer? Yes.... Q2: If a plan or issuer covers some forms of oral contraceptives, some types of IUDs, and some types of diaphragms without cost sharing, but excludes completely other forms of contraception, will the plan or issuer comply with PHS Act section 2713 and its implementing regulations? No.... Q3: If multiple services and FDA-approved items within a contraceptive
method are medically appropriate for an individual patient, what is a plan or issuer required to cover without cost sharing? ... [T]he plan or issuer may use reasonable medical management techniques to determine which specific products to cover without cost sharing with respect to that individual.... Q4: If a plan or issuer covers oral contraceptives (such as the extended/continuous use contraceptive pill), can it impose cost sharing on all items and services within other FDA-identified hormonal contraceptive methods (such as the vaginal contraceptive ring or the contraceptive patch)? No.... Q5: Can plans or issuers limit sex-specific recommended preventive services based on an individual's sex assigned at birth, gender identity or recorded gender? No.... Q6: If a plan or issuer covers dependent children, is the plan or issuer required to cover without cost sharing recommended women's
preventive care services for dependent children, including recommended preventive services related to pregnancy, such as preconception and prenatal care? Yes.... Q7: If a colonoscopy is scheduled and performed as a preventive screening procedure for colorectal cancer pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy? No. "
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
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