QUESTION

I thought that contraceptives were now covered, but I heard on the news that some employers don’t have to cover them. Is that true?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

Generally, employer-sponsored health insurance must provide contraceptive coverage without cost-sharing unless your plan is a grandfathered plan. See Resources, ACA Consumer Protections for Private Coverage for information about grandfathered plans.

Note that a recent change in federal rules allows eligible organizations including employers and insurers that have an objection based on “sincerely religious beliefs or moral convictions” to exclude some or all contraceptives from a health plan, and a previous process in place to ensure enrollees still had access to contraceptive coverage is no longer required. The U.S. Supreme Court recently allowed these rules to go into effect, but they are subject to further legal proceedings. And, some fully insured employer coverage is also subject to state laws that require contraceptive coverage. To determine if your current policy covers contraceptives, and what methods are covered, check with your plan administrator. You should be able to request plan materials that list covered and excluded services, including contraceptives.

This is an area that is constantly evolving. Contact the National Women’s Law Center here if your employer or insurer says contraception is not covered or you experience cost-sharing that is not allowed under the law. Also, check with your state insurance department to see if there are other ways to access free or low-cost contraception if your employer plan does not provide coverage. (CMS, ACA Implementation FAQs – Set 36, Jan. 9, 2017; 29 CFR § 2520.104b-2; 45 CFR. §§ 147.131 – 147.133).

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