Women’s Preventive Services Coverage and Religious Organizations
Thanks to the Affordable Care Act, most health plans cover
recommended women’s preventive services, including contraception,
without charging a co-pay or deductible. The scientists and other
experts at the independent Institute of Medicine provided
recommendations to the Department of Health and Human Services (HHS)
regarding which preventive services help keep women healthy and should
be covered without cost-sharing. The IOM recommended covering
contraception without a co-pay or deductible because there are
tremendous health benefits for women that come from using contraception.
In fact, nearly 99% of all women have relied on contraception at some
point in their lives, but more than half of all women between the ages
of 18 and 34 have struggled to afford it.
Today, the Obama
Administration moved forward to continue to implement provisions in the
health care law that would provide women contraceptive coverage without
cost sharing, while taking into account religious objections to
contraceptive services by certain religious organizations. The Notice of
Proposed Rulemaking (NPRM) released today reflects the public feedback
from comments on the Advance NPRM issued in March 2012.
Today’s
proposals build on the ideas we laid out last year to provide women with
coverage for recommended preventive care, including contraceptive
services, without cost sharing, while also ensuring that non-profit
organizations with religious objections won't have to contract, arrange,
pay, or refer for insurance coverage for these services to their
employees or students.
Details on these proposed policies are
outlined below. The Administration is seeking comment on these
proposals and welcomes feedback from all Americans through
April 8, 2013.
Exemption for Religious Employers
Group
health plans of “religious employers” are exempted from having to
provide contraceptive coverage, if they have religious objections to
contraception.
Today’s NPRM would simplify the existing definition of a “religious employer” as it relates to contraceptive coverage.
The NPRM would eliminate criteria that a religious employer:
- have the inculcation of religious values as its purpose;
- primarily employ persons who share its religious tenets; and
- primarily serve persons who share its religious tenets.
The
simple definition of “religious employer” for purposes of the exemption
would follow a section of the Internal Revenue Code, and would
primarily include churches, other houses of worship, and their
affiliated organizations, as defined by Section 6033(a)(3)(A)(i) or
(iii)
This proposed change is intended to clarify that a house of
worship would not be excluded from the exemption because, for example,
it provides charitable social services to persons of different religious
faiths or employs persons of different religious faiths. The
Departments believe that this proposal would not expand the universe of
employer plans that would qualify for the exemption beyond that which
was intended in the 2012 final rules.
Creating Accommodations for Non Profit Religious Organizations
Consistent
with the Advance NPRM, the NPRM proposes accommodations for additional
non profit religious organizations, while also separately providing
enrollees contraceptive coverage with no co-pays. An eligible
organization would be defined as an organization that:
- opposes
providing coverage for some or all of any contraceptive services
required to be covered under Section 2713 of the PHS Act, on account of
religious objections;
- is organized and operates as a nonprofit entity;
- holds itself out as a religious organization; and
- self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage.
Under
the proposed accommodations, the eligible organizations would not have
to contract, arrange, pay or refer for any contraceptive coverage to
which they object on religious grounds.
In addition, under the
proposed accommodations, plan participants would receive contraceptive
coverage through separate individual health insurance policies, without
cost sharing or additional premiums. The issuer would work to ensure a
seamless process for plan participants to receive contraceptive
coverage.
With respect to insured group health plans, the
eligible organization would provide the self-certification to the health
insurance issuer, which in turn would automatically provide separate,
individual market contraceptive coverage at no cost for plan
participants. Issuers generally would find that providing such
contraceptive coverage is cost neutral because they would be they would
be insuring the same set of individuals under both policies and would
experience lower costs from improvements in women’s health and fewer
childbirths.
With respect to self-insured group health plans, the
eligible organization would notify the third party administrator, which
in turn would automatically work with a health insurance issuer to
provide separate, individual health insurance policies at no cost for
participants. The costs of both the health insurance issuer and third
party administrator would be offset by adjustments in
Federally-facilitated Exchange user fees that insurers pay.
The
NPRM also proposes that an eligible religious non profit organization
that is an institution of higher education that arranges for student
health insurance coverage may avail itself of an accommodation
comparable to that for an eligible organization that is an employer with
an insured group health plan.
The NPRM on women’s preventive services coverage is available here:
http://www.ofr.gov/inspection.aspx.
For more information on women’s preventive services coverage, visit:
http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html.
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