Administration Clarifies Women’s Preventive Services Requirements

Administration Clarifies Women’s Preventive Services Requirements

WASHINGTON—Today, the National Health Law Program (NHeLP) issued the following statement strongly supporting the clarifying guidance released in a frequently asked questions (FAQ) document by the Departments of Health and Human Services, Labor and the Treasury, regarding consumers’ rights to coverage of preventive services under the Affordable Care Act (ACA).

“Today’s guidance will bring needed clarity and help to ensure that individuals are actually able to access the contraceptive method of their choice and related care without cost-sharing, as required by law,” said Elizabeth G. Taylor, NHeLP executive director.

The FAQ makes clear that non-grandfathered plans and insurers must cover, without cost sharing, at least one form of contraception within each of the 18 method categories of contraception that the FDA has identified for women, as well as all clinical services needed for provision of those methods. The FAQ also contains important clarifications to ensure that individuals have timely access to particular contraceptive products within each of the method categories as medically appropriate. Additionally, the FAQ addresses barriers to coverage for transgender individuals, and clarifies that plans or issuers may not limit sex-specific recommended preventive services based on an individual’s sex assigned at birth, gender identity, or recorded gender.

“We are grateful to the Administration for acknowledging and taking action to stop harmful and illegal insurance practices that go against standards of care and inappropriately limit contraceptive choices,” said Susan Berke Fogel, NHeLP director of reproductive health. “Quality family planning care is patient-centered and requires that individuals be given meaningful, affordable access to the full range of contraceptive options. We are especially pleased to see the Administration take steps to end discrimination against transgender individuals.”

The ACA was a major step forward in helping people get the health care services they need to stay healthy. Tens of millions of women are eligible to receive coverage of various preventive services, including all FDA-approved contraception and related services, without having to pay a co-pay or deductible. Recent reports, however, have found numerous examples of health plans that fail to cover all FDA-approved methods of contraception as required, or place unreasonable restrictions on access for transgender individuals. Today’s guidance will go a long way to address these barriers and make the promise of the ACA a reality for many more individuals.

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