Insurance Coverage of Women's Health Services to Be Expanded

Article excerpt

IN A MAJOR step toward recognizing the value of prevention, women's health services such as contraception, domestic violence counseling and cervical cancer screening will be covered by health insurance plans without co-pays, the U.S. Department of Health and Human Services announced in August.

Adopted as part of the Affordable Care Act, the new guidelines for health insurance plans are geared toward closing gaps in existing preventive services for women. New health plans will be required to cover the benefits as of August 2012.

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"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," Health and Human Services Secretary Kathleen Sebelius said.

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The move to cover contraception without co-pays was widely praised by health advocates and heralded as a way to reduce the nation's unintended pregnancy rate, which stands at about 50 percent. The guidelines specify that women have access without co-pay to all U.S. Food and Drug Administration-approved contraception, including sterilization procedures. HHS also released a rule, now open for comment, that exempts religion-based employers from providing coverage for contraceptive services.

"Too many times, I have seen women who became pregnant when they didn't want to because their insurance failed them--by limiting them to contraceptives that weren't right for them or refusing to pay for any form of birth control," said Nancy Stanwood, MD, MPH, secretary of the board of directors for Physicians for Reproductive Choice and Health, in a statement praising the new contraceptive guidelines.

Besides contraception, the guidelines require health plans to cover without co-pay an annual "well-woman" visit that provides preventive services, including preconception and prenatal care; screening for gestational diabetes; and DNA human papillomavirus screening. Other new requirements call for coverage of counseling for sexually transmitted infections as well as screening and counseling for domestic violence and HIV.

While the Affordable Care Act already addressed breastfeeding when it was passed, requiring employers to provide breaks and lactation areas for nursing mothers, the new guidelines further that progress, requiring coverage of lactation support and counseling as well as costs for breastfeeding equipment.

Health insurance plans that are grandfathered are not affected by the new guidelines, but may choose to adopt them. Grandfathered plans are those that were created or purchased on or before March 23, 2010, when the Affordable Care Act was signed into law. Most health plans are expected to lose their grandfather status over time, according to HHS.

The new guidelines are based on recommendations of an Institute of Medicine committee, which released a report on women's preventive services in July. Created at the request of HHS, the report examined women's preventive services covered under the Affordable Care Act and determined whether the list was incomplete.

"Our charge, very specifically, was to look at the evidence on whether services work or not," said APHA member Linda Rosenstock, MD, MPH, chair of the report's authoring committee and dean of the University of California, Los Angeles, School of Public Health. "We do approach this task, and so does the Affordable Care Act, that where you're successful with prevention, that's a very cost-effective tool."

Following the report release, APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E), sent a letter to Sebelius "in strong support" of the report and urged HHS to adopt the evidence-based recommendations. …