The Patient Protection and Affordable Care Act, also known as Health Care Reform, requires non-grandfathered health plans to cover contraceptive services for women with no out-of-pocket costs (i.e., $0 cost-sharing). There are two exceptions to this requirement:
- Religious employer exemption. Religious employers can elect not to provide contraceptive coverage, and their employees are not eligible for contraceptive coverage.
- Non-profit religious organizations and closely held corporations. Non-profit religious organizations and closely held corporations with religious objections to the coverage of contraceptives do not have to cover contraceptives for their employees and dependents.
For non-profit religious organizations and closely held corporations that elect not to cover contraceptives, Health Care Reform requires Independence to pay the cost of certain contraceptive services for eligible employees and eligible dependents.
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 an in-network level with no cost-sharing under the medical benefit and covered with no cost-sharing for generic products and for those brand products for which we do not have a generic equivalent under the pharmacy benefit at retail and mail-order pharmacies.*
For these members, it is important that only contraceptive services are billed using the ID number on the Contraceptive Coverage ID card.*
Contraceptive Coverage ID card samples
For more information
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 Independence prescription drug plan.