Medicare Part D-Industry News

ACA Contraceptive Mandate Guidance

The Department of Labor (DOL), Department of Health and Human Services (HHS), and the Treasury Departments issued frequently asked questions (FAQs) in relation to the contraceptive coverage mandate under the Affordable Care Act (ACA). Non-grandfathered plans, under the ACA, are required to cover specific women’s preventative health services without cost sharing as per the Public Health Service Act (PHS Act).

As a result of reported noncompliance, the Departments released new guidance, featuring 14 FAQs, with a focus on adhering to the contraceptive coverage mandate. The guidance addresses federal preemption of state law and the application of the contraceptive coverage mandate regarding fertility awareness-based methods and emergency contraceptives.

FAQs

Questions featured in the 14 frequently asked questions include:

  1. “Are plans and issuers required to cover FDA-approved emergency contraception, including emergency contraception that is available over-the-counter (OTC)?”
    1. Yes, when the product is prescribed to an individual, plans and issuers must cover without cost-sharing emergency contraception (levonorgestrel and ulipristal acetate) and related OTC products. Additionally, plans and issuers have the option to cover emergency OTC contraceptive products purchased without a prescription.
  2. “Can a health savings account (HSA), health flexible spending arrangement (health FSA), or health reimbursement arrangement (HRA) reimburse expenses incurred for OTC contraception obtained without a prescription?”
    1. Yes, OTC contraception can be reimbursed through an HSA, health FSA, or HRA when the cost is not covered by another plan or coverage.
  3. “What actions will the HHS take if a state law is determined to prevent the application of PHS Act 2713?”
    1. Through this Act, states have primary enforcement authority over the market requirements in Part A of title XXVII of the PHS Act. However, the Secretary of HHS can make a determination that a state has failed to enforce a provision of Part A of title XXVII of the PHS Act, allowing the Secretary to enforce the provision in that state.

If you have questions regarding the FAQs on the contraceptive coverage mandate, please contact your dedicated Creative Benefits, Inc. team member.