While most employer-sponsored health plans cover a broad array of preventive services for women — the result of years of activism and new laws — many require members to share the cost by applying co-pays, deductibles or co-insurance. Plans purchased by individuals are also far less likely to offer such comprehensive coverage.
The mandate applies to private insurance and will take effect beginning Aug. 1, 2012, as plans renew.
In a news conference Monday, Sebelius cast the new rules as part of a broader effort in the new health-care law to build a nationwide system focusing on prevention. But she also said they were crucial to another of the law’s goals: “to bring fairness to the health insurance market for women.”
Specifically, the law directed the administration to come up with a detailed catalogue of preventive services for women that all new health plans must cover without co-pays, co-insurance or deductibles.
As expected, the list released by Sebelius is identical to one recommended last month by a panel of experts from the National Academy of Sciences’ Institute of Medicine, which she had charged with advising her.
The rules cover all prescription contraception approved by the Food and Drug Administration, including emergency options such as the so-called morning-after pill sold as Plan B and the more recently approved drug sold as Ella.
“Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it,” Sebelius said. “Not doing it would be like not covering flu shots.”
The new rules also apply to:
●“well-woman” checkups at least once a year and more frequently if necessary
●screening for diabetes in pregnant women
●DNA testing every three years for human papillomavirus (HPV) — which is linked to certain cancers — in women 30 years and older
●annual screening and counseling for HIV
●counseling to determine whether a woman is at risk for other sexually transmitted infections
●breast-feeding support, counseling and supplies such as breast pumps
●annual screening and counseling for domestic violence
Insurers will be able to keep their spending in check by continuing to charge patients out-of-pocket costs for brand-name drugs in cases where less expensive generic substitutes are available.
Administration officials estimated that the impact on plan premiums would be “minimal,” but declined to give a figure. Karen Ignagni, president of America’s Health Insurance Plans, which represents the insurance industry, disputed that prediction.