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How Does Where You Work Affect Your Contraceptive Coverage?

Infographic: How Does Where You Work Affect Your Contraceptive Coverage?

The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved contraceptives and services for women, as prescribed. Since the implementation of this provision in 2012, some nonprofit and for profit employers with religious objections to contraceptives have brought legal challenges to this rule. For many women today, their contraceptive coverage depends on their employer or when they purchased their individual insurance plan.

Who has a plan that includes contraceptive coverage?

Women who have a non-grandfathered health insurance plan through an employer (either their own, their spouse’s or their parent’s) that does not have a religious objection to providing coverage for contraceptives are insured for the full range of prescribed FDA approved contraceptives without cost-sharing. Women who purchase an individual insurance policy that started August 1, 2012 or later also have full contraceptive coverage.

Women who work for religiously-affiliated nonprofits such as universities or health systems that have a religious objection to contraception typically have coverage for contraceptive services, although the employer will not have to pay for this coverage. Eligible nonprofits that object can file for an “accommodation” to the rule by either completing the EBSA 700 self-certification form or notifying HHS in writing about their objection (also providing the plan name, type and contact information for the health plan or the third party administrator). The accommodation releases these nonprofit employers from the requirement of paying for contraceptive coverage, and assures that the employees and their dependents are still able to obtain full coverage for contraceptives directly from the insurer as they are entitled to by federal law.

A series of lawsuits, however, have been filed by certain nonprofit religiously affiliated employers, claiming that the federal accommodation and the notification to insurers violates their religious beliefs by making them “complicit” in the provision of contraceptive coverage to their workers. These cases are pending in the federal courts. The nonprofit corporations continuing to pursue legal challenges are seeking an “exemption” from the rule, not an accommodation. In a major case involving for profit employers, Hobby Lobby v. Burwell, the Supreme Court ruled that “closely held” corporations may exclude contraceptives from their health plans if their owners have sincerely held religious objections as determined by a court. On July 10, 2015 HHS issued rules requiring closely held corporations to comply with an accommodation rather than allowing an exemption. Beginning with the new plan year, Hobby Lobby and other similar corporations will now be required to notify their insurer or HHS of their objections to contraceptive coverage so that the insurer can still provide the contraceptive coverage directly to the employees and their dependents. These regulations have the effect of restoring contraceptive coverage to workers employed by closely held corporations with religious objections.

Who may not have contraceptive coverage in their plan?

Women who work for a house of worship that objects to contraceptive coverage do not have guaranteed coverage for the full range of FDA approved contraceptives. Houses of worship are exempt from the contraceptive coverage requirement. Women enrolled in student health plans may not have contraceptive coverage without cost-sharing because the rules for student health plans depend on whether the college has a self-insured plan or a fully insured plan. Colleges or universities that purchase insurance from a health insurance company are required to provide contraceptive coverage for women. Religious institutions of higher education with objections to providing contraceptive services are eligible for an accommodation and do not have to pay for coverage, but faculty, staff and students will still have no-cost contraceptive coverage provided by the health insurance company. Student health plans that are self-insured, however, may not be required to cover contraceptive services without cost-sharing because it’s up to states to set that policy, and not federal law, in the cases of self-insured student plans.

Women enrolled in grandfathered plans may not have contraceptive coverage. Grandfathered health plans are plans that were in existence on March 23, 2010 and have stayed basically the same. These plans are not required to provide all of the benefits, including preventive health services, required of other health plans.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.