Bottom line: For plan years beginning on or after August 1, 2012, new plans and non grandfathered plans must offer with no cost sharing, certain preventive care and screenings for women. Exemptions may be allowed for certain religious employers.
Background
The Affordable Care Act (ACA) incorporates sections of the Public Health Services (PHS) Act into ERISA and the Internal Revenue Code. Section 2713 of the Public Health Service Act is one of the incorporated sections.
Section 2713 prohibits cost sharing with respect to:
- Certain evidence-based items or services
- Certain immunizations for children and adults
- Certain evidence-based preventive care and screenings for infants, children and adolescents and
- Certain preventive care and screening for women provided for in comprehensive guidelines supported by Health Resources and Services Administration (HRSA)
HRSA was charged with developing guidelines regarding preventive care and screenings for women. Interim final regulations were issued August 3, 2011 as well as an amendment to exempt religious employers from the requirement to cover contraceptive services. Comments are due on or before September 30, 2011.
Preventive Services
HRSA provides the following list of preventive services:
- Well-woman visits
- Screening for gestational diabetes
- Human papillomavirus testing
- Counseling for sexually transmitted infections
- Counseling and screening for human immune-deficiency virus
- Contraceptive methods and counseling
- Breastfeeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
What should Plan Sponsors do?
If you are a religious employer, determine if you meet the definition of religious employer in the regulations.
If your plans are insured, confirm that your insurance carrier will include the required preventive services, determine the cost impact and remember to communicate the changes during the applicable open enrollment.
If you are self-insured, work with your claims administrator to ensure that claims will be processed accordingly and address the same issues noted above for insured plans.
Keep in mind that if you wish to comment on the regulation, comments are due on or before September 30, 2011.
You may want to check our new blog periodically for quick updates on compliance issues.
Note: all links are active as of the date of issuance of this ErisaALERT.
Disclaimer: This material is for the sole purpose of providing general information and does not under any circumstances constitute legal advice and should not be used as a substitute for legal advice. You should seek the advice of counsel when applying the requirements to your plan. For more information on this ErisaALERT contact us by phone at 610-524-5351 and ask for Mary Andersen or 973-994-7539 and ask for Theresa Borzelli.
