Regulatory Resources
The Affordable Care Act (ACA) introduced changes to how many self-insured health plans cover preventive services.
More on Preventive Health
The legislation's provisions on preventive health coverage began affecting non-grandfathered health plans for plan years beginning on or after Sept. 23, 2010. The ACA requires non-grandfathered health plans to provide 100 percent coverage for certain preventive services and immunizations provided by a network doctor or hospital. Cost-sharing requirements, such as copayments, deductibles or coinsurance, are prohibited for preventive health provided by a network healthcare provider. However, such health plans are not required to provide coverage for preventive services from non network hospitals and doctors, and they may impose a cost-sharing requirement when the services are provided out of network.
Contraceptive Services
For plan years on or after Aug. 1, 2012, the ACA requires non-grandfathered health plans to provide coverage for contraceptive services to women without cost-sharing. However, through a series of regulations and guidance documents, exceptions have been made for "religious employers" and "eligible organizations."
To learn more about preventive benefits, read:
- Current Women’s Preventive Services HRSA guidelines
- List of ACA FAQ’s and descriptions including FAQ’s on preventive services.
Follow this link to view the most current HRSA Women’s Preventive Services Guidelines. Based on recommendations developed by the Women's Preventive Services Initiative, the updated guidelines complement and build upon recommendations from organizations such as the U.S. Preventive Services Task Force.