The Affordable Care Act (ACA) requires health plans to cover preventive services and eliminates cost sharing for those services. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.
Women’s Preventive Services Guidelines Supported by the Health Resources and Services Administration (HRSA)
Under the ACA, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – generally must be covered by health plans with no cost sharing.
The HRSA-supported health plan coverage guidelines were developed by the Institute of Medicine (IOM). HHS commissioned an IOM study to review what preventive services are necessary for women’s health and well-being and therefore should be considered in the development of comprehensive guidelines for preventive services for women. HRSA is supporting the IOM’s recommendations on preventive services that address health needs specific to women and fill gaps in existing guidelines.
Health Resources and Services Administration (HRSA) Women’s Preventive Services Guidelines
Non-grandfathered plans (plans or policies created or sold after March 23, 2010, or older plans or policies that have been changed in certain ways since that date) generally are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012.
|Type of Preventive Service||HHS Guideline for Health Insurance Coverage||Frequency|
|Well-woman visits.||Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception care and many services necessary for prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713.||Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors. * (see note)|
|Screening for gestational diabetes.||Screening for gestational diabetes.||In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.|
|Human papillomavirus testing.||High-risk human papillomavirus DNA testing in women with normal cytology results.||Screening should begin at 30 years of age and should occur no more frequently than every 3 years.|
|Counseling for sexually transmitted infections.||Counseling on sexually transmitted infections for all sexually active women.||Annual.|
|Counseling and screening for human immune-deficiency virus.||Counseling and screening for human immune-deficiency virus infection for all sexually active women.||Annual.|
|Contraceptive methods and counseling. ** (see note)||All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.||As prescribed.|
|Breastfeeding support, supplies, and counseling.||Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.||In conjunction with each birth.|
|Screening and counseling for interpersonal and domestic violence.||Screening and counseling for interpersonal and domestic violence.|
* Refer to guidance issued by the Center for Consumer Information and Insurance Oversight entitled Affordable Care Act Implementation FAQs, Set 12, Q10. In addition, refer to recommendations in the July 2011 IOM report entitled Clinical Preventive Services for Women: Closing the Gaps concerning distinct preventive services that may be obtained during a well-woman preventive services visit.
** The guidelinesconcerning contraceptive methods and counseling described above do not apply to women who are participants or beneficiaries in group health plans sponsored by religious employers. Effective August 1, 2013, a religious employer is defined as an employer that is organized and operates as a non-profit entity and is referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code. HRSA notes that, as of August 1, 2013, group health plans established or maintained by religious employers (and group health insurance coverage provided in connection with such plans) are exempt from the requirement to cover contraceptive services under section 2713 of the Public Health Service Act, as incorporated into the Employee Retirement Income Security Act and the Internal Revenue Code. HRSA also notes that, as of January 1, 2014, accommodations are available to group health plans established or maintained by certain eligible organizations (and group health insurance coverage provided in connection with such plans), as well as student health insurance coverage arranged by eligible organizations, with respect to the contraceptive coverage requirement. See Federal Register Notice: Coverage of Certain Preventive Services Under the Affordable Care Act (PDF – 327 KB)