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When can plans limit coverage of particular contraceptives?

The federal government requires that plans must cover at least one form of contraception in each the 18 methods for women identified by the FDA. A plan may also use reasonable medical management techniques such as prior authorization or step-therapy, and require cost-sharing to encourage an individual to use specific services or items within a chosen FDA approved contraceptive method. The plan must have a process in place to ensure that your particular contraceptive service or product is covered without cost sharing when your provider recommends it based on medical necessity.  In addition, you must get your contraceptive care from an in-network provider.  Insurers may charge cost sharing if you go to an out-of-network provider for contraceptive care.

In addition, an employer could also limit the types of contraceptives they wish to cover if they are exempt based on a religious or moral objection to some or all contraceptive methods.  Employer could choose to exclude coverage for IUDs or emergency contraceptive pills, or any other method selectively based on their religious or moral beliefs.

 

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.