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Health Care Reform: Additional ACA Guidance on Preventative Care Coverage Released - February 20, 2013

Today federal regulators released additional guidance on the Affordable Care Act’s preventative care requirements for non-grandfathered plans, including additional information on contraceptive coverage.  


According to the new guidance, non-grandfathered plans must cover all FDA-approved contraceptives prescribed by the member’s provider without cost-sharing not just oral contraceptives. The guidance also provides that consistent with past guidance a plan may use reasonable medical management techniques to control costs. For example, a plan could cover generic contraceptives at 100% but imposing cost sharing on equivalent brand names. However, the plan must have a process for waiving the cost-sharing if the generic drug would be medically inappropriate as determined by the member’s provider.  


The new guidance also provides information on other preventative care issues, including well-woman visits, breastfeeding counseling, domestic violence screening and polyp removals performed during colonoscopies.  


A copy of the guidance can be accessed at http://www.dol.gov/ebsa/faqs/faq-aca12.html