The Women’s Health Mandate
What are the new benefits that are being added as a result of the legislation?
- Covered women will be able to receive the following at no member cost-share:
- Annual well-woman visits, including pre-conception and prenatal care
- Screening for gestational diabetes
- Counseling on sexually transmitted infections and testing for human papillomavirus
- FDA-approved contraceptive methods (drug coverage not required, but CDPHP formulary applies)
- Lactation counseling and rental of breastfeeding equipment
- Annual screening and counseling for domestic violence
Who does the Women’s Health Mandate affect?
The coverage pertains to members of employer groups, Healthy New York, Direct Pay, and CDPHN self-insured groups. It does not affect members covered by Medicaid, Child Health Plus, Family Health Plus, or Medicare. Non-profit religious organizations may qualify for an exemption from the contraception coverage. If a group is grandfathered with regard to the Affordable Care Act preventive benefits, the enhancement does not apply.
When will the changes take effect?
The law directs that the benefits be effective upon group renewals after August 1, 2012, but CDPHP chose to apply them for most of our groups as of August 1, 2012. For members covered by the Federal Employees Health Benefits Plan (FEHBP) plan or New York State Health Insurance Program (NYSHIP), the benefits will be added on January 1, 2013 (the renewal date for these groups).