Carriers Must Cover Certain Contraceptives Without Cost Sharing

On August 7, 2020, the Division of Insurance issued Bulletin 2020-26, requiring insurance carriers to provide contraceptives without cost sharing. As background, the ACA’s preventive care mandate was interpreted to require coverage of contraceptives. Massachusetts followed suit and incorporated the requirement to offer contraceptives in Massachusetts law through Chapter 120 of the Acts of 2017. This bulletin updates Massachusetts’ guidance on this requirement.

Specifically, the bulletin discusses the different FDA-approved contraceptive methods and clarifies that carriers can choose to cover more than one product of each method (and could even charge for additional products) as long as at least one version is provided without cost sharing. Carriers must also provide a specific contraceptive without cost sharing if an individual’s physician recommends that particular product based on a medical determination. Additionally, coverage for voluntary female sterilization procedures and FDA-approved emergency contraception must be allowed without a prescription. The bulletin goes on to require that carriers provide coverage for patient education and counseling on contraception and follow-up services related to the contraception.

The bulletin exempts churches or qualified church-controlled organizations from its requirements provided that the church gives employees a written notice stating that they will not offer contraceptives or certain methods for religious reasons, and defines such an organization.

The bulletin and Chapter 120 are already effective and insurers must ensure continuing compliance. Employers should be aware of this guidance.

Bulletin 2020-26 »