Health Insurers Ordered to Heed Law on Free Contraception Coverage
By: Robert Pear (NY Times) May 2015
WASHINGTON — The Obama administration on Monday put health insurance companies on notice that they must cover all forms of female contraception, including the patch and intrauterine devices, without imposing co-payments or other charges.
In the last month, the National Women’s Law Center and the Kaiser Family Foundation issued separate reports that found that insurers often flouted a federal requirement to provide free coverage of birth control for women under President Obama’s health care law.
Senator Patty Murray of Washington, the senior Democrat on the Senate health committee, and Gretchen Borchelt, a vice president at the law center, praised the action by the administration.
“Insurance companies have been breaking the law, and today the Obama administration underscored that it will not tolerate these violations,” Ms. Borchelt said. “It is now absolutely clear that all means all — all unique birth control methods for women must be covered.”
In addition, the administration said that insurers must cover genetic testing and counseling for certain women who have a family history of breast or ovarian cancer. Specifically, it said, insurers must cover testing for mutations in the BRCA1 and BRCA2 genes, which can increase a woman’s risk of developing breast or ovarian cancer.
The new guidance also makes clear that insurers should cover preventive services for transgender people when a doctor finds that the services are medically appropriate.
Insurers cannot deny coverage or charge for “sex-specific recommended preventive services” because of a person’s gender identity or their sex assigned at birth, the government said.
“Tens of millions of women are eligible to receive coverage of recommended preventive services without having to pay a copay or deductible,” said Sylvia Mathews Burwell, the secretary of health and human services. “Today we are clarifying these coverage requirements.”
Federal officials also told insurers that they could not charge for anesthesia services provided in connection with colonoscopies performed as a preventive service.
Ms. Murray and other congressional Democrats had urged the administration to clarify the coverage rules. The new guidance guarantees that more women receive “the health care they are entitled to,” including contraception, Ms. Murray said.
“The F.D.A. currently identifies 18 distinct methods of contraception for women,” the administration said.
But researchers at the National Women’s Law Center found that some insurers lumped together several methods of contraception and covered only one or two in a category. For example, they said, some insurers did not cover the contraceptive patch or the vaginal contraceptive ring because they covered another “hormonal method” of contraception, like birth control pills.
Under the new guidance, such restrictions are not allowed. For example, it says, insurers “may not impose cost sharing on the ring or the patch.”
Insurance companies had generally denied that they were violating federal standards for coverage of preventive services.
The new guidance was provided in a series of questions and answers issued jointly by the Departments of Health and Human Services, Labor and the Treasury.
