On May 25, 2018, Gov. Malloy signed HB 5210 into law. The new law requires small employer plans to provide coverage for certain preventive care services with no cost sharing to participants. The coverage is similar to that required of non-grandfathered plans under the ACA, but the state mandate will also to grandfathered plans and will remain in place even if the federal requirement is repealed or altered.
The law also requires certain treatment for women, children and adolescents and seems aimed at protecting some of the preventive services guaranteed by the ACA on the state level (should the ACA be repealed, and based on the changes to the contraceptive mandate).
Specifically, plans must provide coverage for preventive care screenings for plan participants age 21 and younger in accordance with most recent edition of American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents or any subsequent corresponding publication. Issuers can't impose coinsurance, copayments, deductibles or other out-of-pocket expenses for coverage of preventive care screenings benefits and services. Cost-sharing when such benefits and services are provided out of network is permissible except in high-deductible health plans that are used to establish HSAs.
Additionally, plans that provide coverage for prescription drugs must provide coverage for immunizations recommended by the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists, and immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention
Plans must also provide coverage for evidence-informed preventive care screenings for infants, children, adolescents and women provided in guidelines supported by the federal Health Resources and Services Administration, as effective on Jan 1, 2018, and such additional preventive care and screenings provided for in any comprehensive guidelines effective after Jan. 1, 2018; and evidence-based items or services that have a rating of ‘A' or ‘B' in the current recommendations of the US Preventive Services Task Force effective after Jan. 1, 2018.
Further, plans must provide coverage for screening and counseling for interpersonal and domestic violence for female plan participants.
And as it pertains to tobacco use by women, plans must provide coverage for tobacco use intervention and cessation counseling for female plan participants who consume tobacco.
In seeking to protect some of the women's services offered under the ACA, the law also requires plans to must also provide certain women's healthcare services coverage for the following preventive care, benefits and services:
- Well-woman visits for female plan participants who are younger than age 65
- Breast cancer chemoprevention counseling for female plan participants who are at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by participants' physicians or advanced practice registered nurses
- Breast cancer risk assessment, genetic testing and counseling
- Gonorrhea, human immunodeficiency virus, chlamydia, cervical and vaginal cancer and sexually transmitted infections screenings for sexually-active female participants
- Human papillomavirus screening for female plan participants with normal cytology results who are age 30 or older
- Anemia screening and folic acid supplements for pregnant female participants and female participants likely to become pregnant
- Hepatitis B and Rh incompatibility screenings for pregnant female participants and follow-up testing for such participants who are at risk for Rh incompatibility
- Syphilis screening for pregnant female participants and female participants who are at increased risk for syphilis
- Urinary tract infection and other infection screenings for pregnant female participants
- Gestational diabetes screening for female participants who are 24-28 weeks pregnant and female participants who are at increased risk for gestational diabetes
- Osteoporosis screening for female participants who are age 60 or older
The same is true of maternity healthcare, and the law requires plans to provide coverage for:
- Anemia screening and folic acid supplements for pregnant female participants and female participants likely to become pregnant
- Rh incompatibility screenings for pregnant female participants and follow-up testing for such participants who are at risk for Rh incompatibility
- Syphilis screening for pregnant female participants and female participants who are at increased risk for syphilis
- Urinary tract infection and other infection screenings for pregnant female participants
- Breastfeeding support and counseling for pregnant or breastfeeding plan participants
- Breastfeeding supplies, including, but not limited to, breast pumps for breastfeeding participants
- Gestational diabetes screenings for female participants who are 24-28 weeks pregnant and female participants who are at increased risk for gestational diabetes
Finally, the law imposes a state requirement for plans to provide coverage for all contraceptive methods. Specifically, plans must provide coverage for the following benefits and services:
- All contraceptive drugs, including, but not limited to, all FDA-approved over-the-counter contraceptive drugs (such plans can require plan participants to use contraceptive drugs designed by the FDA as therapeutically equivalent to contraceptive drugs prescribed to participants prior to using prescribed contraceptive drugs, unless participants' prescribing health-care providers determine otherwise)
- All contraceptive devices and products, excluding all FDA approved over-the-counter contraceptive devices and products (such plans can require plan participants to use contraceptive devices or products designated by the FDA as therapeutically equivalent to contraceptive devices or participants' prescribing providers request less than a 12-month supply. Participants aren't entitled to receive a 12-month supply of such contraceptive drugs, devices, or products more than once during any policy year
- All FDA-approved sterilization procedures for female plan participants
- Routine follow-up services related to FDA-approved contraceptive drugs, devices and products
- Counseling in FDA-approved contraceptive drugs, devices, and products and proper use of such drugs, devices, and products
Keep in mind, though, that the law includes a Religious Employer Exemption. Essentially, employers that are organized to promote religious beliefs, such as churches and church-affiliated organizations aren't required to offer plans that provide coverage for prescription contraceptive methods if contraceptive use conflicts with employer's' religious beliefs. Employers that are organized to promote religious beliefs, such as churches and church-affiliated organizations, aren't required to offer plans that provide coverage for contraceptive benefits and services if contraceptive use conflicts with employers' religious beliefs. There's no specific action required of employers in this regard, but employers with fully-insured plans in Connecticut should work with insurers to understand the required coverage and update the plan accordingly.
Public Act No. 18-10 »