Recent guidance issued jointly by the U.S. Departments of Labor, Health and Human Services and the Treasury clarifies how the Affordable Care Act's requirement to provide cost-free coverage for preventive care applies to several types of products and services.

In particular, the guidance clarifies that:

  • Coverage for all types of contraception (currently 18 different types are recognized) must be provided cost-free to plan participants. Plans may implement cost-sharing for medical management purposes (for example, to encourage the use of generic over brand-name products), but must have an efficient and transparent process in place to make exceptions to those cost-sharing requirements in accordance with an attending physician's recommendation.
  • Coverage of well-woman care that is subject to the preventive care rules must be offered cost-free to qualifying dependent children as well as to employees and spouses.
  • In applying preventive service recommendations that are sex-specific to particular individuals (for example, a transgender individual), the recommendations of the attending physician need to be observed.
  • Certain counseling, screening and testing for breast cancer must be provided cost-free to women with a personal history of breast cancer that has not been diagnosed as having certain genetic links.
  • Cost-free coverage for colonoscopies includes anesthesia services.

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Employee Benefits and Executive Compensation
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