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Health Care Reform Enhanced Womens Preventive Services

What You Need to Know About: Enhanced Women’s Preventive Services

On 7/14/2010, the Department of Health & Human Services (HHS) released the list of A and B services determined by the US Preventive Services Task Force. These preventive services were categorized by adult, women and pediatric services. In the Department of Labor’s (DOL) Interim Final Rules released on 7/19/2010, the DOL also stated that additional preventive services for women were still being debated for inclusion. On 8/1/2011, the DOL issued Interim Final Rules on Enhanced Women’s Preventive Services resulting in considerable media coverage particularly concerning oral contraceptives now being payable with no cost share, such as a copay. However, the actual implementation of the new preventive services provisions is more complicated and the rules are still subject to change.
 
 
No, grandfathered plans do not need to comply with this provision. If, in the future, your health plan loses its grandfathered status, this reform will apply to your plan.
A grandfathered plan can voluntarily choose to comply with the provision and when the 2010 list of preventive services were released in July, 2010, some grandfathered plans did choose to comply and provide some, if not all, of the preventive services on the list with no cost share to the participant. The DOL rules for enhanced women’s preventive services does not address this scenario so the opinion is that a grandfathered health plan can still voluntarily decide to provide some, or all, of the services listed with no cost share to the participant.
 
 
In addition to the 15 women’s preventive services issued on 7/19/2010 that included anemia screenings, mammography screenings, cervical cancer screenings, etc., 8 additional preventive services have been added:
  • Well-woman visits, annually
  • Gestational diabetes screenings for pregnant women between 24 and 28 weeks of gestation and at first prenatal visit for pregnant women at high-risk of diabetes
  • Human papillomavirus testing beginning at age 30 and no more frequently than once every 3 years
  • Counseling for sexually transmitted infections, annually
  • Counseling and screening for HIV, annually
  • Contraceptive methods and counseling, as prescribed
  • Breastfeeding support, supplies and counseling in conjunction with each birth
  • Screening and counseling for interpersonal and domestic violence, annually
 
Health plans must be in compliance on the first day of the first new plan year following 8/1/2012. As a result, if your health plan normally renews every July, you would not have to be in compliance until 7/1/2013 although the DOL, as usual, does encourage early compliance.
 
The DOL Interim Final Rules expressly states that they are sensitive to violating the religious freedom of an employer whose religious tenet is in conflict with providing coverage for oral contraceptives. For this reason, the DOL has provided an exemption for those employers who meet the following criteria:
  • Has the inculcation, or teaching, of religious values as its purpose;
  • Primarily employs persons who share its religious tenets;
  • Primarily serves persons who share its religious tenets; and
  • Is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii)
     

Yes, there is a chance. Whenever the DOL releases Interim Final Rules they also provide a time period, usually 60 days, for comments and there have been precedents in which a provision in the Interim Final Rules has been removed. However, these situations are rare and, as a plan sponsor, you should not rely upon repeal and instead prepare for implementation of all the provisions in the Interim Final Rules.
 
The DOL has not issued any clear guidance or sample language to be used in communicating the changes in enhanced women’s preventive services to plan participants. If your plan is fully-insured, it will be the responsibility of your insurance carrier to develop and distribute communication materials to the plan participants. If your plan is self-funded, you should work closely with the claim administrator to develop and distribute the needed materials.
Regardless of whether your plan is fully-insured or self-funded, you will also need to follow standard ERISA disclosure procedures, such as:
  • Summary of Material Modifications (SMM) – As always, anytime a change is made to a plan design, an SMM should be sent to the plan participants.
  • Summary Plan Description (SPD) – The plan’s SPD should be updated with the new Preventive Services benefits.

In addition, you should also “prominently” display the new list of enhanced women’s preventive services in any open or new enrollment materials. 
 
The DOL estimated that the cost for implementing the preventive services issued on 7/19/2010 will result in a +1.5% increase in costs in either premium or claims. They did not provide any revision to that figure with the release on the enhanced women’s preventive services rules.

8.  What do I need to do now? 
  • If your religious tenet is in conflict with providing coverage for oral contraceptives, then contact your insurance carrier, third party administrator and/or the DOL with your comments. Otherwise….
  • If you are a non-grandfathered plan, you should discuss this new provision with your insurance carrier or claims administrator to begin preparations to implement this reform on the first day of the first plan year beginning on or after 8/1/2012.
  • Lastly, if you are subject to this new provision, you need to begin preparing your communication strategy for the upcoming open enrollment, and ongoing, to educate your plan participants on what is now available to them at 100%.

We will continue to update you as additional guidance is released. In the interim, if you have any questions on this or any new health care reform regulation, please contact a member of your Banyan Consulting team.