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Employers must provide preventive health care services to women: Rules


WASHINGTON—Group health care plans would have to provide full coverage—with neither copayments nor deductibles—for a wide range of women’s preventive services under rules issued Monday.

The rules stemming from the 2010 health care reform law and jointly issued by the departments of Health and Human Services, Labor and Treasury, require full coverage with no plan enrollee cost-sharing for services such as well-woman visits; screening for gestational diabetes; sexually transmitted infection counseling; breastfeeding support, supplies and counseling; domestic violence screening; and U.S. Food and Drug Administration-approved contraception methods and counseling.

2012 start date

The mandate would apply for plan years starting on or after Aug. 1, 2012. For calendar years, compliance would begin on Jan. 1, 2013. However, what are known as “grandfathered plans” would be exempt from having to meet the requirements.

In addition, religious organizations would not be required to cover contraceptives if it is inconsistent with their beliefs. A religious employer is one that, among other things, primarily employs individuals who share its religious beliefs and primarily serves those who share in its religious beliefs, according to the regulations, which are scheduled to be published in Wednesday’s Federal Register.

While the vast majority of plans will have to expand coverage to comply with the rules, employers should have sufficient time to make the needed changes, said Susan Margolis, a director with PricewaterhouseCoopers L.L.P. in New York.

Compared with the overall cost of coverage, the new requirement will result in “very modest” cost increases, said Rich Stover, a principal with Buck Consultants L.L.C. in New York.

The women’s preventive services come about a year after regulations mandating coverage—except for grandfathered plans—for a wide range of other preventive services, such as blood pressure, diabetes and cholesterol tests and annual physicals.