Guidance Issued on Birth Control Coverage
In response to President Biden’s Executive Order regarding protecting access to reproductive health care, the Departments of Health and Human Services, Labor, and Treasury released an FAQ regarding coverage of birth control as preventive care under the Affordable Care Act (ACA). Under the ACA, most plans must cover contraceptives with no cost share, consistent with guidelines issued by the Department of Health and Human Services.
The recent guidance emphasizes coverage requirements previously outlined by the Departments. Previous guidance stated that plans must cover items and services that are integral to providing the preventive service. This new FAQ clarifies that this includes coverage for anesthesia for a tubal ligation procedure or pregnancy tests necessary before certain forms of contraceptives.
Previous guidance explained that plans must cover at least one form of the 18 categories of contraceptives described in HHS guidelines and other FDA-approved contraceptive products that a provider has determined to be medically appropriate. The 18 categories are (1) sterilization surgery for women, (2) surgical sterilization via implant for women, (3) implantable rods, (4) copper intrauterine devices, (5) intrauterine devices with progestin (all durations and doses), (6) the shot or injection, (7) oral contraceptives (combined pill), (8) oral contraceptives (progestin only), (9) oral contraceptives (extended or continuous use), (10) the contraceptive patch, (11) vaginal contraceptive rings, (12) diaphragms; (13) contraceptive sponges, (14) cervical caps, (15) female condoms, (16) spermicides, (17) emergency contraception (levonorgestrel), and (18) emergency contraception (ulipristal acetate). Plans must also cover any FDA-approved contraceptive product that a provider has determined to be medically appropriate, even if it is not included in one of the 18 categories. Plans may use reasonable medical management techniques for contraceptive products or services not included in the 18 categories, but only if multiple, substantially similar services or products are available and are medically appropriate for the individual.
The FAQ additionally emphasizes that plans must also cover over-the-counter emergency contraception and encourages plans to cover the dispensing of a 12-month supply of contraception, although it is not required.