On August 1, 2011, the Department of Health and Human Services (HHS) released guidelines requiring group health plans and health insurers offering group or individual health insurance coverage to cover certain preventive health services for women free of charge. The preventive service rules do not apply to plans that are grandfathered under the Affordable Care Act (ACA).

The new guidelines provide specific guidance on complying with regulations previously issued under the ACA, which requires certain health plans to cover preventive services without cost sharing. Under the guidelines, plans and insurers must provide the following benefits without charging a copayment, deductible or coinsurance:

Health plans must include these services for plan years beginning on or after August 1, 2012. According to the rules governing preventive services generally, plans can use reasonable medical management techniques in defining the nature of the covered service, including the frequency, method, treatment or setting for the service. They also retain the flexibility to control costs and promote efficient delivery of care, for example by permitting cost sharing for branded drugs if an equally effective and safe generic version is available.

Also on August 1, 2011, HHS, the Department of Labor and the Internal Revenue Service issued an amendment to the prior regulations that exempts group health plans sponsored by certain religious employers from the requirements to cover contraceptive services. The amendment includes a four-part test for determining whether an organization is a "religious employer." For example, the organization must primarily employ individuals who share its religious tenets.

For more information, see Practice Note, Coverage of Preventive Health Services under the ACA.