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.
Instead, the new rules “would increase the number of unnecessary physician office visits and raise the cost of coverage,” she said in a statement.
The list of women’s services issued Monday supplements a broader version for all populations released last summer under the health-care law and now in effect. It requires all new private health plans to cover at no additional cost preventive services, such as mammograms, Pap smears, colonoscopies, immunizations, blood pressure tests and screening for patients at risk for certain sexually transmitted infections.
As part of Monday’s announcement, officials proposed an exception: religious institutions that offer insurance to their workers would have the option of refusing to include birth control. Officials said the policy was modeled on the most common accommodation for churches found among 28 states that already require insurers to cover contraception.
The proposal, which is open for public comment over the next month, dismayed women’s rights advocates such as Judith Waxman of the National Women’s Law Center.
“We think that all women should have access to these services through their health plans,” she said. “This was not in the statute. . . . We hope [the administration] reconsiders and does not go this route.”
By contrast, Sister Mary Ann Walsh of the U.S. Conference of Catholic Bishops decried the exemption as too narrow. It would apply only to institutions whose purpose is to inculcate religious values and that primarily employ and primarily serve people sharing the organization’s religious tenets.
“The bishops are concerned that this would exclude most Catholic social service agencies and health-care providers, so it’s not much of an exemption at all,” Walsh said.
Catholic hospitals and Catholic charities such as food pantries don’t limit themselves to helping only Catholics, she noted. “Serving all people in need is part of the mission of the church.”
Some religious and socially conservative groups also objected to the inclusion of emergency contraception, such as Plan B and Ella. Both drugs mainly work by inhibiting ovaries from releasing eggs. But antiabortion advocates contend there is evidence the drugs can also prevent an already-fertilized egg from implanting in the womb, which they consider equivalent to abortion.
Plans that were in existence before the health-care law was adopted are exempt from the new rules. However, such plans can lose their grandfathered status if they make a range of changes to their policies that limit benefits or increase members’ costs. Administration officials predict that by 2013, 34 million women aged 18 to 65 will be in plans covered by the rules.