Almost all group health plans must cover in-network preventive services and immunizations without cost-sharing (e.g., deductibles, coinsurance, and copayments) or annual limits.
Preventive care services and immunizations include:
- Recommended evidence-based preventive services from the United States Preventive Services Task Force with a rating of A or B
- Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
- Preventive care guidelines developed by the Health Resources and Services Administration and the American Academy of Pediatrics
- Women’s preventive services, including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening (certain group health plan sponsors may be exempt from covering contraceptive services, see below)
Contraceptive coverage exemption rules:
Rules finalized under the ACA offer accommodation for eligible organizations that object to covering contraceptive services. Only religious employers – churches or houses of worship as defined by the Internal Revenue Code – can qualify for the exemption. Under the ACA rules, other eligible employers who objected to covering contraceptives on religious grounds were required to self-certify with their insurance carrier or third-party administrator (TPA) or file a notice with the Department of Health and Human Services (HHS). This process placed the responsibility of covering contraceptive services on the insurance carrier or TPA, and ensured the customer/individual policyholder had no cost share expenses for such services.
Final rules issued on Nov. 7, 2018 by multiple federal agencies were set to expand the exemption for employers to not cover contraceptive services under their sponsored group health plans for both religious and moral objections. On Jan. 14, 2019, a Pennsylvania federal court issued a preliminary injunction that prevents the rules from being implemented in any state unless or until the injunction is removed. The injunction maintains the status quo and rules in place under the ACA.