Preventive contraceptive coverage is required unless the employer qualifies for an exemption.
Most non-grandfathered group health plans must cover contraceptive services without cost sharing as preventive care. Federal rules let some employers opt out on religious or moral grounds. Which route applies depends on who you are and how the plan is funded.
Covered as preventive care.
The requirement comes from the Affordable Care Act’s preventive services provision as carried out in HRSA guidelines.
What It Covers
Contraceptive items, procedures and services, and related education and counseling, as specified in the guidelines, at no cost to the member in network.
Who It Applies To
Non-grandfathered group health plans, insured and self-funded. Grandfathered plans are exempt from the preventive services requirements as long as they keep that status.
Insured Plans
For an insured plan, the carrier’s product determines what is covered. An employer should not assume it can remove a benefit that is built into the policy.
Religious and moral, in two sections of the regulations.
Both can apply to the same employer. The scope depends on the objection.
Religious Objections
Section 147.132 lets churches and religious orders, nonprofits, and other non-governmental employers, including closely held and other for-profit entities, exclude contraceptive coverage to the extent of a sincerely held religious objection.
Moral Objections
Section 147.133 covers nonprofits and for-profit employers with no publicly traded ownership interests that have sincerely held moral convictions. It works the same way.
Carriers and Individuals
Issuers can be exempt too, and an exempt carrier does not automatically exempt the employer. A willing issuer may offer an objecting individual a separate option that omits contraceptive coverage.
What to document and ask.
The regulations lay out who may be exempt. The mechanics are between the employer, the carrier or administrator, and the plan documents.
Choose the Path
Decide with your adviser whether you object, to which services, and whether that is consistent with your mission and the exemption language. The exemption applies only to the extent of the objection.
Coordinate the Documents
The plan document and summary plan description have to describe what the plan covers. A self-funded employer needs the administrator to administer the exclusion. An insured employer needs a carrier willing to offer a product without it.
Expect Change
These rules have been litigated and amended more than once. Confirm the current rule with your carrier and counsel before relying on an exemption.
What employers ask about contraceptive coverage.
Can any employer opt out?
No. The exemptions are for sponsors with a sincerely held religious or moral objection, and the moral exemption excludes entities with publicly traded ownership.
If we are fully insured, can we just exclude it?
Only if the carrier offers a plan without it. The carrier’s filed products govern, and state insurance rules can also apply to insured plans.
Do employees have to be told?
The plan documents and benefit summaries should accurately describe what is covered. The exemption section itself does not set a separate notice rule, so the notice comes through the plan documents.
Related guides.
Preventive Services
What a plan must cover without cost sharing.
Church Plans and Religious Employers
Benefits rules for religious employers.
ERISA Compliance Checklist
The documents and notices a plan needs.
Tell us what your plan covers today.
We’ll tell you what your carrier or administrator offers, what the plan documents need to say, and the questions to raise with your counsel. No cost, and no obligation.
Your carrier and funding type
Whether the plan is grandfathered
Your plan document and summary plan description
The specific coverage question
Rough answers are fine. We build the numbers from there.
Laws and rules referenced
45 CFR 147.132 — Religious exemptions in connection with coverage of certain preventive health services.
45 CFR 147.133 — Moral exemptions in connection with coverage of certain preventive health services.
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