The Patient Protection and Affordable Care Act, also known as Health Care Reform, requires non-grandfatheredhealth plans to cover contraceptive services for women with no out-of-pocket costs (i.e., $0 cost-sharing). There aretwo exceptions to this requirement:
- Religious employer exemption. Religious employers can elect not to provide contraceptive coverage, and theiremployees are not eligible for contraceptive coverage.
- Non-profit religious organization. Non-profit religious organizations can elect not to cover contraceptives forreligious reasons but are not exempt as a ?religious employer.?
For these non-profit religious organizations, Health Care Reform requires IBC to pay the cost of certain contraceptive services for eligible employees and eligible dependents of non-profit religious organizations that elect not to cover contraceptives.
Eligible members within these organizations will receive a separate ID card that indicates ?Contraceptive Coverage.?Using this ID card, contraceptive methods approved by the U.S. Food and Drug Administration will be covered at anin-network level with no cost-sharing under the medical benefit and covered with no cost-sharing for generic productsand for those brand products for which we do not have a generic equivalent under the pharmacy benefit at retail andmail order pharmacies.*
Contraceptive Coverage ID card samples
For a complete listing of medical contraceptive services, please refer to the current version of Medical Policy#00.06.02: Preventive Care Services.
Please contact your Network Coordinator if you have any questions about this coverage or billing.
*Contraceptive services are covered under the pharmacy benefit only if the member has an IBC prescription drug plan.