Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector

Under final regulations titled “Coverage of Certain Preventive Services under the Affordable Care Act” qualifying entities may now avail themselves of the accommodation to effectively exempt them from the otherwise applicable requirement to cover certain contraceptive services. To avoid contracting, arranging, paying, or referring for contraceptive coverage, an organization seeking to be treated as an eligible organization under the final regulations may self-certify (by using EBSA Form 700), that it meets the definition of an eligible organization. The self-certification will not be submitted to any of the Departments. The organization must maintain the self-certification in its records in a manner consistent with ERISA section 107 and make it available for examination upon request. The eligible organization must provide a copy of its self-certification to each health insurance issuer that would otherwise provide such coverage in connection with the health plan (for insured group health plans or student health insurance coverage). The issuer that receives the self-certification must provide for separate payments for contraceptive services for plan participants and beneficiaries (or students and dependents). For a self-insured group health plan, the self-certification must be provided to its third party administrator. An eligible organization may also submit a notification to HHS as an alternative to submitting the EBSA Form 700 to the eligible organization’s health insurance issuer or third party administrator. A health insurance issuer or third party administrator providing or arranging payments for contraceptive services for participants and beneficiaries in plans (or student enrollees and covered dependents in student health insurance coverage) of eligible organizations must provide a written notice to such plan participants and beneficiaries (or such student enrollees and covered dependents) informing them of the availability of such payments. To satisfy the notice requirement, issuers and third party administrators may use the model language set forth in the 2013 final regulations or substantially similar language. Employers that under the previous rules had used the accommodation process, but can now be exempt may now choose to revoke their use of the accommodation process, but in order to do so they must provide participants and beneficiaries written notice of such revocation as soon as possible. In an effort to consolidate the number of information collection requests, the Department is combining OMB control numbers 1210-0150 and 1210-0152 which will cover the private sector (for-profit and not-for-profit) . Once 1210-0150 is approved the Department will discontinue 1210-0152.

The latest form for Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector expires 2021-11-30 and can be found here.

Self-Certification or Notification

Federal Enterprise Architecture: Health - Health Care Services

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