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August 3, 2011

HRB 37 - Preventive Care Coverage Expanded to include Women’s Health Services

Released August 3, 2011I Download as a PDF

August 3, 2011 -- The Patient Protection and Affordable Care Act (PPACA) requires individual and group health plans to provide preventive coverage, without imposing any cost-sharing requirements (co-payment, co-insurance, or deductible), when such services are delivered by in-network providers. These rules apply to both non-grandfathered individual and group health plans, including both insured and self-funded plans; the rules do not apply to grandfathered plans. About a year ago, the governing Agencies issued interim final rules defining the parameters of certain preventive services (see CBIZ Health Reform Bulletin, Preventive Health Services).

On August 3, 2011, the governing Agencies released a proposed amendment to the interim final regulations, modifying the definition of preventive health care, specific to women’s health care. These regulations would require coverage of:

  • Annual well-women care visits, including preconception and prenatal care.
  • Gestational diabetes screening for certain high-risk pregnant women.
  • Human papillomavirus/DNA test screening every 3 years, beginning at age 30.
  • Annual counseling for sexually transmitted infections.
  • Annual counseling and screening for human immune-deficiency virus.
  • Contraceptive methods and counseling, including coverage for prescribed FDA- approved contraceptive methods and sterilization procedures. Group health plans sponsored by certain religious employers would be exempt from the requirement to cover contraceptive services. A religious employer is defined as one that:
  1. Has the inculcation of religious values as its purpose;
  2. Primarily employs persons who share its religious tenets;
  3. Primarily serves persons who share its religious tenets; and
  4. Is a non-profit organization, as defined by IRC Section 6033.
  • Breastfeeding support and counseling during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.
  • Annual screening and counseling for interpersonal and domestic violence.

These regulations become effective on the first plan year beginning on or after August 1, 2012.

Additional information:


About the Author: Karen R. McLeese is Vice President of Employee Benefit Regulatory Affairs for CBIZ Benefits & Insurance Services, Inc., a division of CBIZ, Inc. She serves as in-house counsel, with particular emphasis on monitoring and interpreting state and federal employee benefits law. Ms. McLeese is based in the CBIZ Leawood, Kansas office.


The information contained herein is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. The information contained herein is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein. As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained herein is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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