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Home ACA Compliance Biden Administration Proposes Rule to Expand Free Birth Control Access Under ACA

Biden Administration Proposes Rule to Expand Free Birth Control Access Under ACA

3 minute read
by Maxfield Marquardt
Biden Administration Proposes Rule to Expand Free Birth Control Access Under ACA

President Joe Biden’s administration released a rule proposal that would require employer-sponsored health plans to cover over-the-counter contraception under the Affordable Care Act (ACA).

In its fact sheet, the Biden admin said it will be the “most significant expansion of contraception coverage under the ACA in more than a decade.”

The proposed rule aligns with Vice President Kamala Harris’ focus on expanding reproductive care, from birth control to abortion to postpartum coverage, as part of her presidential bid in the Nov. 5 election.

What the Rule Entails 

The proposed rule comes from the Departments of Health and Human Services (HHS). If passed, according to the Biden administration, the rule would:

  • Expand coverage of over-the-counter contraception without cost sharing. Under the proposed rule, for the first time, women would be able to obtain over-the-counter (OTC) contraception without a prescription at no additional cost. As a result, more women would be able to access and afford critical OTC medications such as emergency contraception and the first-ever daily oral contraceptive approved by the Food and Drug Administration (FDA) for use without a prescription that is now widely available across the country.
  • Make it easier to learn about coverage for OTC contraception. To help ensure that women understand this new benefit, most private health plans would be required to disclose that OTC contraception is covered without cost sharing and without a prescription — and take steps to help women learn more about their contraception coverage.
  • Strengthen coverage of prescribed contraception without cost sharing. The proposed rule would make it easier for most women with private health insurance to obtain contraception without cost sharing that is prescribed by their health care provider. Health plans would be required to cover every FDA-approved contraceptive drug or drug-led combination product without cost sharing unless the plan also covers a therapeutic equivalent without cost sharing, eliminating barriers that some women continue to face in accessing contraception prescribed by their provider.

The proposed rule will undergo a 60-day public comment period. If elected president, it’s sure to be a focal point of VP Harris’ attempt to expand the ACA.

What it Means for ACA Compliance 

The Biden administration has made reproductive rights under the ACA a focus. That is likely to continue if Harris is elected president. The rule is unlikely to move forward under a Donald Trump administration, so it will be another thing to monitor come Election Day.

If the rule is eventually put into place, Applicable Large Employers will need to ensure health plans adapt to meet this new Minimum Essential Coverage (MEC) and affordable requirement.

Additionally, employers would need to disclose the new benefit to employees and document through applicable healthcare forms 1094-C and 1095-C. The rule also mandates employers educate women on their coverage and communicate that a prescription is not required.

Health plans would be required to cover every FDA-approved contraceptive drug or drug-led combination product without cost sharing unless the plan also covers a therapeutic equivalent without cost sharing. This means employers will need to work with their healthcare provider to update the plan to include these measures, while finding ways to keep coverage under the same MV and affordability requirement mandated by the ACA.

Ensure Your Organization Is in Compliance 

So, come this November, there’s a lot at stake when it comes to healthcare and the ACA. Regardless, employers should remain diligent in keeping up with the responsibilities of the ACA’s Employer Mandate as the IRS increases its focus and attention to detail on non-compliance.

If you need assistance with ACA compliance and the subsequent year-end filing, contact Trusaic. Our comprehensive ACA Complete® software offers all the resources employers need to achieve full ACA compliance and eliminate penalty risk.

From preparing 1095-C forms and conducting monthly monitoring to performing safe harbor calculations, handling year-end ACA filings, and providing IRS audit defense, Trusaic has assisted thousands of clients in eliminating billions in ACA penalties.

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Biden Administration Proposes Rule to Expand Free Birth Control Access Under ACA
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Biden Administration Proposes Rule to Expand Free Birth Control Access Under ACA
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The proposed rule would require employers’ health plans to cover over-the-counter contraception at no additional cost to employees under ACA.
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