Contraceptives and Closely Held For-Profit Entities

The U.S. Departments of Health and Human Service (HHS), Labor and the Treasury released final regulations affecting how contraceptive service benefits are paid for participants that are covered under non-grandfathered group health plans sponsored by closely held for-profit entities that object to covering some or all contraceptive services on religious grounds.

The new regulations finalize 2014 interim final rules requiring an insurer, or third-party administrator that agrees, to provide reimbursement for contraceptive services without cost sharing when provided in-network to participants when an eligible non-profit organization objects to providing coverage of some or all contraceptive services on religious grounds.

The final regulations extend this accommodation to for-profit entities that meet the following two conditions:

• The company must be a closely held for-profit entity, which is defined as not being publicly traded and having an ownership structure under which more than 50 percent of the value of its organization’s ownership interest is owned directly or indirectly by five or fewer individuals, or has an ownership structure that is substantially similar as of the date of the entity’s self-certification or notice to the HHS Secretary.
• The for-profit’s highest governing body must adopt a resolution or similar action establishing that it objects to covering some or all contraceptive services on account of the owner’s sincerely held religious beliefs.

The new final regulations become effective on the first day of the first plan year that begins on or after Sept. 14, 2015.

For more information on contraceptive coverage, follow this link.